Charitable Gift Annuity Illustration Request Form Charitable Gift Annuity Illustration Request Form About you the donor(s)Donor #1 name(Required) First Middle Last Suffix Donor #1 birthdate(Required) MM slash DD slash YYYY Donor #2 name First Middle Last Suffix Donor #2 birthdate MM slash DD slash YYYY State of Residency(Required) Type and amount of asset you will useIf you are using cash to fund this CGA, what is the deposit amount?If you are using a non-cash asset to fund this CGA, what is that non-cash asset? What is today's approximate value of this asset?What is the cash basis of this asset?Type of Gift Annuity - Please choose Immediate, Deferred, or Flexible DeferredOption 1: Immediate Immediate Interval of payment Quarterly Semi-Annually Annually If annually, which month and day do you choose? Month Day Year Option #2: Deferred Deferred Deferred to when? Month Day Year Option #3: Flexible Deferred Flexible Deferred Earliest start date? Month Day Year Approximate date you expect to make this gift: Month Day Year NameThis field is for validation purposes and should be left unchanged.
