Charitable Gift and Annuities

Contact Form for a Charitable Gift Annuity
* = required field

*First name:
*Last name:
*Address:
*City
*State:
*Zip/Postal code:
*Email address:
*Phone:
best time to call:
Amount of Charitable Gift Annuity:	(minimum $10,000):
If CGA will be funded with publicly-traded securities, what is the cost basis?
Type of CGA: Check one:	Single Life Two lives
Payment preference for two lives:	Jointly Consecutively “jointly” = payments to both annuitants, then to surviving annuitant until death “consecutively” = payments to first annuitant until death, then to second annuitant until death
Preference for annuity payments:	Annual Semi-annual Quarterly
Date annuity payments should begin:
Annuitant's Name: if two lives
Annuintant's Name:
Date of Birth:
male or female:
Date of Birth:
male or female:
Questions/Comments:

Harvest Foundation