Donation Form

HAPPY TRAILS

Happy Trails Therapeutic Horsemanship P.O. Box 270 Waterloo, IL 62298  Mr.  Mrs.

 Miss

DONATION FORM

 Ms.

 Mr. & Mrs.  Other ____________________

Name

Spouse’s name

Contact Telephone Preferred (

)

-

 Home  Work  Mobile

Address

E-Mail Address

City/Town Zip Code

Gift Amount I am pleased to support Happy Trails Therapeutic Horsemanship:

 Honorary  Memorial  Other Total Gift Amount Method of Payment (please select by checking one of the payment methods) Check or cash sent with filled out donation form to Happy Trails Therapeutic Horsemanship, P.O. Box 270, Waterloo, IL 62298.  By Check Please make checks payable to “Happy Trails”. Please start my payments on: _____/_____/_______ MM DD YYYY

 Annually

 Quarterly

 Monthly

 One time gift

 Other__________

 Annually

 Quarterly

 Monthly

 One time gift

 Other__________

 Annually

 Quarterly

 Monthly

 One time gift

 Other__________

 By Cash Please start my payments on: _____/_____/_______  By PayPal Please start my payments on: _____/_____/_______ MM DD YYYY

Recognition  For the purpose of recognition, I/ We would like our names to appear as follows (please print clearly):

OR:



I wish to remain anonymous

_________________________________________________________________________________

Signature _________________________________________ All donations are tax deductible and will be receipted accordingly.

Date ___________________________________