Mass Intention Request Form

The Parish must receive the Mass stipend before a Mass can be scheduled. Please make the payment online after submitting this request form. The amount of the Mass stipend is left to your discretion.

Type of Mass

Type of Mass In memory of ________. Special intention of ________. ________ in Thanksgiving.
Name of the person, family or group for whom Mass will be said. Name of the person, family or group for whom Mass will be said. First Last
PLEASE REQUEST THREE (3) SPECIFIC DATES AND TIMES TO ENSURE AVAILABILITY.

First Option
Date and Time PLEASE REQUEST THREE (3) SPECIFIC DATES AND TIMES TO ENSURE AVAILABILITY.

First Option
Date and Time / MM / DD YYYY
Second Option
Date and Time Second Option
Date and Time / MM / DD YYYY
Third Option
Date and Time Third Option
Date and Time / MM / DD YYYY
Person requesting the Mass Intention Person requesting the Mass Intention First Middle Last
Phone Phone - ### - ### ####
Email
IF CARD REQUESTED:

Name of Recipient IF CARD REQUESTED:

Name of Recipient First Middle Last
Address of Recipient Address of Recipient
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
MASS STIPEND $ Dollars . Cents
AFTER SUBMITTING THE MASS INTENTION, PLEASE MAKE THE PAYMENT ONLINE.

AFTER SUBMITTING THE MASS INTENTION, PLEASE MAKE THE PAYMENT ONLINE. By checking this box, I certify that I have read and verified that all the information above is complete and accurate, and that I will proceed to make a payment online via OSV in the amount listed above. I hereby consent to and authorize the necessary procedures stated above.