My/Our Planned Gift

Name(Required)

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Address

Street Address Address Line 2 City State ZIP Code

I have included a gift to The Lighthouse for the Blind, Inc. in support of Lighthouse programs.

This gift is designated for The Lighthouse for the Blind, Inc. endowment

Yes

This gift is designated to be used as follows:

Where it's most needed

For a specific program

Please select the appropriate program from the dropdown menu below:(Required)

This type of gift is

A percentage of my total assets to be distributed in my will

A monetary donation in the amount

A remainder gift

I have named The Lighthouse for the Blind, Inc. as a beneficiary to the following accounts: (please list owners name(s) and account numbers)

Other type of gift

Percentage of assets(Required)

Dollar amount:(Required)

Remainder gift details:(Required)

Account name(s) and details(Required)

Other Gift Details(Required)

Comments, questions, or other information you would like to tell us:

Signature

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Today's Date

If not signed by donor, please tell us your relationship to the donor:

Name

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