gift annuity inquiry form

The information you provide does not obligate you to establish a gift annuity. The illustration will show the amount of annuity payments you would receive and the tax benefit available to you.

1. I am interested in an illustration for:

One life Two lives

2. The illustration would be in the amount of:

Other Amount:

(enter amount without $ sign)

3. The property contributed would be:

Approximate cost basis for property other than cash:

(enter amount without $ sign)

4. Names and dates of birth for annuitants (those who will receive annuity payments):

First annuitant:

Title :
First Name * :
Last Name * :
E-mail Address * :
Address * :
City * :
State * :
Zip * :
Daytime Phone :
Evening Phone :

Second annuitant (optional):

Title :
First Name :
Last Name :
E-mail Address :
Address :
City :
State :
Zip :
Daytime Phone :
Evening Phone :

5. Names and address of Donor: (optional)

Title :
First Name :
Last Name :
E-mail Address :
Address :
City :
State :
Zip :
Daytime Phone :
Evening Phone :

* = required field