Contact Information

First Name

Last Name

Street Address

City

Postal Code

State

Email

Phone Number

I use these pronouns

He/ Him/ HisShe/ Her/ HersThey/ Them/ TheirsOtherPrefer not to say

Pronoun - Other

Birthdate

MM/DD/YYYY

Please check here to add partner or spouse information

Partner/ Spouse Contact Information

First Name

Last Name

Email

Phone Number

I use these pronouns

He/ Him/ HisShe/ Her/ HersThey/ Them/ TheirsOtherPrefer not to say

Pronoun - Other

Birthdate

MM/DD/YYYY

Legacy Gift Plan Information

E-Signature (I agree that my electronic signature shall have the same force and effect as my written signature)

Date

Type of Legacy Gift

WillDonor Advised FundLife Insurance BeneficiaryRetirement Plan/ IRALiving TrustOther

Please add any other details you wish to share

I/We anticipate our future gift will be approximately (% or amount)

This form is non-binding and does not constitute a legal promise of any future donation. We understand your estate plans may change.

Purpose of the Legacy Gift to Metro Caring

May we list you as a Perennial Roots member in our publication?

I give permission to publish my name in your Annual Report

How would you like your name to appear in our annual report?