Application Form for an Entry in the Chantry Book - The Shrine Of Our Lady Of Walsingham

Please make your Chantry Book donation of £30 using a Debit or Credit Card. When you click the submit button, you will be asked to fill in your details. Please note that you can either use your PayPal account (if you have one) or make a guest payment using your card.

Payment method
*
- Debit or Credit card
Donation details
There is a minimum charge of £30 per entry in the Chantry Book.
Please accept my donation of*
Name of the Deceased & Dates for the Chantry Book entry:
First name*
Last name*
Date of Birth (dd/mm/yyyy)
Date of Death (dd/mm/yyyy)
Your details
Title*
First name*
Last name*
Address 1*
Address 2
Town*
County
Postcode
*
Country
Email*
Telephone*
Gift Aid Declaration
If you are a UK taxpayer, the value of your gift can be increased by 25% under the Gift Aid scheme. On your behalf, we simply claim back the tax from HM Revenue & Customs - all you have to do is tick the box below.
Please read the information on Gift Aid before completing.

I want the charity, WCTA Ltd (Walsingham College Trust Association Limited), to treat this and all other donations I make from the date of this declaration until I notify you otherwise as Gift Aid donations.
This Gift Aid declaration will remain in place until cancelled by you.
*
- Yes
- No

Payment method

Donation details

Name of the Deceased & Dates for the Chantry Book entry:

Your details

Gift Aid Declaration