CGA Request 2023 (secured.heritage.org/cga-now)

Your name *

First Name*

Last Name*

Address *

Address Line 1

Address Line 2

City

State

ZIP Code

Phone Number *

Email Address *

Your date of birth

Month

Day

Year

Please choose the type of gift annuity you are interested in:
Single Life (The remainder of the annuity would go to The Heritage Foundation at the end of your life.) Two Life (Annuity payouts to you or your loved one would continue until you both pass away. At that time the remainder would go to The Heritage Foundation.)

Please enter the name of the second person you would like to add to the annuity:

First Name

Last Name

Please enter his or her date of birth:

Month

Day

Year

Choose your annuity amount
$10,000 $25,000 $50,000
Other: Other Value

Minimum required gift is $5,000

I would fund the annuity with:
Cash Stock

If the stock has appreciated, what was the cost basis/purchase price?

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