The Mandala of Supporting Friends Program

Yes! I'd like to pledge my ongoing support for Aryaloka! I will make regular monthly contributions toward ensuring Aryaloka's financial future.

Simply print this form, fill it out and mail it to us at the address below. All donations are fully tax-deductible.

Aryaloka Buddhist Center
14 Heartwood Circle
Newmarket, NH 03857

Thank you very much for your generosity!

(If you'd prefer to make a one-time donation instead, click here.)

Donor Information

Name:__________________________________________

Address:_______________________________________

City:__________________________________________

State:__________________________________________

Zip:___________________________________________

Phone:_________________________________________

Email:_________________________________________

Comments:_____________________________________

Payment Method

Please choose one of the payment methods below and fill out the appropriate section.

1. Preauthorized Checking Account Withdrawals

I authorize the Friends of the Western Buddhist Order, herein after called ORGANIZATION, to initiate debit entries to my checking account indicated below in the amount indicated per month; and the depository institution, named below, herein after called DEPOSITORY, to debit the same to such account.

Amount per month:________________________________

Depository Name:_________________________________

Branch Name:_____________________________________

City:____________________________________________

State:___________________________________________

Zip Code:________________________________________

Routing Number:__________________________________

Account Number:__________________________________

I have enclosed a voided check (yes/no):_________

This authority is to remain in full force and effect until ORGANIZATION and DEPOSITORY have received written notification from me of its termination in such time and in such manner as to afford ORGANIZATION and DEPOSITORY a reasonable opportunity to act on it.

Signature:_________________________________________

Today's date:_______________________________________

2. Credit Card Payments

I authorize the Friends of the Western Buddhist Order to charge my credit card for the amount indicated per month for the length of time indicated.

Amount per month:____________________

Payments to continue for ______ months from __________ through ___________.

Card Type: (MC or VISA only)______________________________

Card Number:___________________________________________

Expiration:_____________________________________________

Signature:______________________________________________

Today's date:___________________________________________

3. Monthly Checks

I will support the Friends of the Western Buddhist Order by mailing a check every month in the amount indicated for the length of time indicated. I will write checks to "FWBO" and mail them to:

Aryaloka Buddhist Center
14 Heartwood Circle
Newmarket, NH 03857

Amount per month:____________________________

Payments to continue for ______ months from __________ through ___________.

My first check is enclosed (yes/no):_________

Signature:___________________________________________

Today's date:________________________________________