Two Life Charitable Gift Annuity

 

Please complete the following information and push “Submit.”  All information will

remain confidential and will be sent directly to the Director of D&D Gift Planning.


 

Today's Date:   Mo.        Day       Year     

First Annuitant Name

                                                                                                                                             

Date of Birth:       Mo.        Day       Year       

Second Annuitant Name:

                                                                                                                                          

Date of Birth:       Mo.        Day       Year       

Address:         Street                                                                            City                                               State             Zip

             

 

Telephone #:                   Fax #:               E-mail:     


 Current Dollar Amount of illustration Annuity: $


Tax Bracket:     %


This Charitable Gift Annuity will be Funded By: 
 

If Using Stocks:


Number of Shares to be Transferred:

   (For Dollar amount of Annuity illustration)

 

Dollar Value of Shares: $
 

How Titled:

Year Purchased: Cost Basis at Purchase:
 

Above Authorized By Annuitant :