MONTHLY SUPPORT





Application



PLEASE FILL OUT ALL SPACES PROVIDED


Name of Organization Or Individual

Organization or Individual Address

Street

City

Zip code

Phone number

Organization OR Individua Billing Address

Street

City

zip code

phone number

Contact person name authorized for payment by your organization

Address of Contact person

Street

City

Zip

Phone number

Payment Method


(Payment in full required with application)


[ ] YES! I would like to support BhaktiRadioNetwork.com and Mystic Mandala in all Hindu Religion based events and promotions they engage in for promoting Art and culture, Yoga and Mediation from India, with the following donation on a monthly basis and receive a newletter from Mystic Mandala. When the mail comes, I should know what they chose

$51     $101     $150     $251     $501    $1001    Other Amount  

Payment type: If you are sending us Checks, please mention check sequence nos and mail the checks to us at Mysitc Mandala 3131 Custer, Ste # 265 Plano TX 75075. All 6 checks MUST be sent at the same time post dated. Please confirm Y/N Check # and sequence

Credit card information

Card No

Name on Card

Expiration Month and year

3 Digit Code

Billing zip code associated with the card

I hereby, confirm that I am authorized to use this card and I agree with the the terms of this agreement on behalf of organization.

By signing this, I agree to allow the card to be deducted the appropriate fees as per the terms of this agreement on the 1st day of every month or prorated. I understand that this support is not for a Non Profit Organization.


Name initials Date