Please note : Ensure that all details entered in this form are correct and are completed in black capitals for ease and legibility. These details will be used on all documentation and cannot be altered. Please also enter full particulars.

 

 

Title Required:

Lord / Sir / Earl etc . ……………………………………………………………………………………..

Your Present title:

Mr / Mrs / Ms / Miss / Master etc .  ……………………………………………………………………..        

First Name:

Example Joseph not Joe  - Catherine not Cathy : ………………………………………………….

Middle Names:

Example johnathan not simply ‘J’ : …………………………………………………………………...

Last Name:

………………………………………………………………………………………………………………..

Date Of Birth:

Day : ………………….  Month: …………………………… Year: ……………………….……………

Nationality:

………………………………………………………………………………………………………………..

 

 

Postal Address:

………………………………………………………………………………………………………………..

 

………………………………………………………………………………………………………………..

Postal Code:

………………………………………………………………………………………………………………..

Country:

………………………………………………………………………………………………………………..

Telephone No.:

(……………) ……………………………………………….……………………………………………….

Mobile No.:

(……………) ………………………………………….…………………………………………………….

Email Address:

…………………………………….………. @ ………………………….…………………………………

 

 

 

 

I wish to purchase the Title as so entered in the sum of £149 (or the Complimentary Titles as so entered in the sum of £249).  I enclosed my payment by the following means (please tick box to indicate payment method ):-

 

·          □ International Money Order

·          □ Personal Cheque

 

Made Payable to Fantaysia ‘The Homestead’ Thurnscoe Road, Bolton-on-Dearne, Rotherham, South Yorkshire. S63 8JW

 

We also accept payment online via either of these secure payment methods. (please tick box to indicate payment method ):-

 

·          □ Nochex

·          □ Paypal

·          □ World Pay

 

Please ensure that you have signed the form below and that you have stated your name, address and telephone number on the payment receipt if paying via any of the online payment methods. Also ensure that you have sent your completed form in the post. We are sorry but we cannot accept faxed or emailed applications forms.

 

Signature :

……………………………………………………………………..

Date:

……………………………………………………………………..

 

 

Important ! Should you wish your Spouse to hold the ‘Complimentary Title’ then they must complete and sign the second application.