Printable Response/Request Form

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This printable form has been provided without headings or navigation links to facilitate printing. You may fill it out on line and then print it. You may mail or fax it to us at:

(845) 334-4781 FAX
Benedictine Health Foundation
105 Mary's Avenue
Kingston, NY 12401

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

Please send me information regarding:

Cash Gift
Appreciated Securities
Real Estate
Bequests
Gifts of Life Insurance
Gifts 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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