Information Request Form

There is no obligation on your part in requesting information or a personal analysis of your financial circumstances. Any information provided by you will be maintained in the strictest of confidences and any response by us is for your informational purposes only.

If you would prefer to mail or fax this information to us, please use our printable form.

Your Name:
Your Title:
E-Mail Address:

     (We must have this to respond to you by e-mail)
Phone Number:
Work Phone:
Mailing Address:
Information Request

I would like more information regarding:

Cash Gift
Gift of Appreciated Securities
Gift of Real Estate
Bequests
Gift of Life Insurance
Gift of Retirement Assets
Charitable Remainder Trusts
Retained Life Estate (definition)

Are you considering a gift currently?


Yes
No
Uncertain

Would you like to inform us of a bequest or other gift?


Yes, I have made a bequest or other planned gift and would be pleased to have my name included as a donor.
Yes, I have made a bequest or other planned gift but I would prefer to remain anonymous.

Additional Comments or Requests
Add to
Mailing List
Yes - please mail to above postal address.
Yes - please e-mail me as above.
No thank you.

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The Benedictine Health Foundation's staff will gladly work with your legal advisor or estate planner to help you create the best plan for your gift.