Cultivate Yoga

Recurring Donation Request Form

Please use this form to request help in setting up recurring donations to the Cultivate community that can be automatically paid with a credit card or deducted from a checking account of your choice.

NOTE: If you are interested in becoming a Cultivate Warrior with us and setting up recurring donations through that program, please follow this link instead: Cultivate Warrior Signup

Recurring donations are available in ANY amount that best fits your ability to support us.

After this form is completed, we will do our best to contact you via phone as soon as possible to obtain your payment information.

We are so grateful for you and your support of this beautiful Cultivate Community!

Name

First Name

Last Name

Email

Phone

(###)

###

####

Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Requested Donation Amount

Please enter the amount you'd like to donate each month

Payment Option

What method would you like use to donate?

Credit/Debit Card

ACH/Direct Withdrawal

Name Share [Cultivate Warrior]

Are you okay with us sharing your name on our website as one of our Cultivate Warriors (community members who support us in special ways)?

Yes, you can share my name

No, please do not share my name

Comments

Please share anything else you would like us to know