Financial Hardship Application

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We do our best to accommodate your financial challenges and strive to provide services to those who are struggling.

IMPORTANT NOTE: please keep in mind that this application is no assurance of working with Blanca, as she has limited availability to accommodate all requests. You may be put on a waiting-list.

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Correo electrónico *

Name *

Today's date *

AAAA

What's your age range? *

<30

30-39

40-49

>50

What is your current monthly income? *

< $1,000

$1,000- 1,500

>1,500

What is your job title? *

Why are you unable to pay the full fee for healing and coaching with Blanca. Explain your financial situation better. *

What fee are you able to contribute toward a coaching/healing session? *

Something you want us to know *

By checking this box, you're taking an oath of honesty and standing by the truth of the information given.

Please note: you don't want to create negative karma that comes from dishonesty or deceit. So please make sure the information here is TRUTHFUL.

I stand by the truth of the information I've provided in this application and understand the risks fo commiting perjury.

In order to keep you updated, you need to confirm that I can add your email to my email list (see my privacy policy here: https://www.blancavergara.com/privacy-statement/) *

I confirm subscription to your email list to stay updated

I don't want to be added to your email list and therefore will not be updated

Se enviará un correo electrónico con una copia de tus respuestas a la dirección que suministraste.

Enviar

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