Memorial Page Submission

Your Details

Your Name*

First Last

Your Email Address*

Your Phone Number*

Your Address*

Street Address City State Postcode

Memorial Details

Name

First Last

Date of birth (optional)

Date of passing (optional)

Message to include on memorial (optional)

Would you like to include an image? (optional)

Please pick a template style from the choices above*

Payment Details

Would you like to donate to Charlie's Gift for this memorial?

How would you like to make this donation?

PayPal
Offline donation

In order to make an offline donation we ask that you please follow these instructions:

For Cheques

Make a cheque payable to "Charlie's Gift Incorporated"
On the memo line of the cheque, please indicate that the donation is for "Charlie's Gift"
Please mail your cheque to:

Charlies Gift Fund Incorporated
123 Victoria Street
New Lambton NSW 2305

For Direct Deposit

Please submit a deposit using the following details:
Name: Charlies Gift Fund
BSB: 646000
Account Number: 100071092
Reference: Your name

All contributions will be gratefully acknowledged and are tax deductible.

Please remember to still submit this form if you are making an offline donation)

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Your Details

Memorial Details

Payment Details

Template choices

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