Survey - St. Joseph's Request for Information - Charitable Gift Annuity

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Name:

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Street 2:

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Phone Number: Required

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Date of Birth: Required

Date of Birth:

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Question - Not Required - I am especially interested in a proposal as follows:

	Single-life annuity (please enter name below, if different than above)
	Joint or Two-lives annuity (please enter names below)

Question - Not Required - First Name:

Question - Not Required - Last Name:

Question - Not Required - Gender:

Question - Not Required - Date of Birth:

Month

Day

Year

Question - Not Required - First Name:

Question - Not Required - Last Name:

Question - Not Required - Gender:

Question - Not Required - Date of Birth:

Month

Day

Year

Question - Not Required - Amount of gift being considered ($5,000 minimum): $

Question - Not Required - Schedule of payments:

Immediate (next regular pay date)

Deferred - first payment not until:

Question - Not Required - Deferral Date:

Month

Day

Year

Question - Not Required - Frequency of payments:

Annual on Dec. 1

Semi-Annual (June 1 & Dec. 1)

Quarterly (gifts of $5,000 or more)

Monthly (gifts of $10,000 or more)

Question - Not Required - Additional comments or questions: