Applicant Name: (required)

Applicant Address: (required)

Applicant Email: (required)

Charity, Organisation or Individual on whose behalf the request is to be made:

Charity Address: (required)

Amount Requested:(required)

Background to Request:(required) Project/Event/Cause and use to which the monies will be put:

Please submit your latest set of financials

Relationship between Applicant and/or the Charity, Organisation or Individual on whose behalf the application
is being made and C J Lang and Son Limited: (required)

Any other details you wish to bring to the attention of the Trustees: