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Charitable Gift Annuity Enrollment Request Form

Please fill out the form below to request an enrollment packet. This information is sent to the Office of Legacy Gifts via our secure server.

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For more information contact giftplans @ uua.org.

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Last updated on Tuesday, January 15, 2013.

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All Information is Confidential
Name:
Street Address:
City/Town:
State/Province:
Zip/Postal Code:
Congregation:
Email:
Telephone (day):
Telephone (evenings):
Best Time to Call:
Person to Receive the Annuity:
Birthdate:
Second Annuitant (if applicable):
Birthdate (if applicable):
Amount of Gift ($10,000 minimum):
Our/My Gift Will Be:	Cash Stock Other (please specify):