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Request Information Form

It takes time and effort to create an effective plan for the future. We would like to help you by creating a personal profile of the gift type that might best suit your needs and goals. In the meantime, feel free to contact us with any questions. I'm not sure which gift plan works best for me. Please contact me. I would like my gift to support: The ALS Association's National Office A Local Chapter of The ALS Association Both the National Office and a local Chapter I'm Not Sure Where to Direct My Gift Chapter: Please select a state Alabama Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nebraska New Hampshire New Jersey New Mexico New York North Carolina Ohio Oregon Pennsylvania Rhode Island South Carolina Tennessee Texas Vermont Virginia Washington West Virginia Wisconsin Please select a chapter I want to explore gifts that provide income to me and/or my beneficiaries. Specifically, I am interested in the following gift plan(s): Charitable Gift Annuity Deferred Gift Annuity Charitable Remainder Unitrust Charitable Remainder Annuity Trust I want to explore: How to make a Bequest. Ways to give Real Estate. Making a gift of Retirement Plan Assets. Ways to pass assets to my heirs while minimizing my tax exposure (Charitable Lead Trusts). Making a gift with Life Insurance. Gifts of Partnership Interests, Closely-Held Stock, or other Tangible Personal Property. Amount to illustrate: Please Select $10,000 $25,000 $50,000 $100,000 $250,000 $500,000 $1,000,000 Type of asset: Please Select Cash Marketable Securities Closely-Held Stock Personal Residence Other Real Estate Partnership Interests Tangible Personal Property Retirement Plan Assets Life Insurance Other Estimated cost basis of asset: Please Select 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Date of birth of income beneficiaries (if applicable): Beneficiary #1 Birth Date (MM/DD/YYYY) Beneficiary #2 Birth Date (MM/DD/YYYY) (For charitable remainder trusts, more than two beneficiaries may be designated) Please send my gift illustration by: Regular mail Fax Email Contact information: Name Street address Daytime telephone with Area Code Apt. or Suite Email City Fax State Zip Security Key* To receive information on how planned gifts can benefit you and your family, just complete the form above and click the send button. Your request is strictly confidential and non-obligatory.