Loose change collector

Name: *

Address: *

Postcode: *

Telephone number:

e-mail:

Please note that by completing your e-mail address, you are indicating your consent to receive e-mails from Church Urban Fund. We will not pass your details to a third party, and you are free to unsubscribe at any point.

Parish (if applicable):

If you attend a church, please tell us its name or the name of the parish.

Preferred box opening month - select up to two:

Please note, if you have a Loose Change Co-ordinator, your box will be opened in the month(s) that they have specified.