Be Free From Worry, Fear and Anxiety

Divine Mercy Image Request Form

Divine Mercy Image Request Form


I would like to be a Guardian and host a Visitation of the Divine Mercy Image. I have obtained my pastor’s permission and have obtained from him some possible dates for the Prayer Service. I understand that I need to form a Guardian Team to do this and to work in cooperation with our pastor to schedule and prepare the Visitation.

You may submit this form with a $25.00 credit card payment or send a check or money order to us. You may also call us at 802-524-5673 with credit card payment. Checks should be made payable to Missionary Image and sent to:

The Missionary Image
144 Sheldon Road
St Albans, VT  05478


* Required

I request a Divine Mercy Image
Our parish will provide its own Divine Mercy Image

Credit Card