Section 1: Donor Information. Unless otherwise requested and specified, the Donors to a family foundation have full and equal rights to recommend grants and to appoint successor charitable advisors to the foundation. For two or more donors, all foundation correspondence will be sent to Donor 1 if the mailing addresses are different. (Please print)
Donor 1
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Name |
Mailing Address |
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Name to be used for all correspondence |
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Date of Birth Age / / |
City State Zip |
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Social Security Number (required) - - |
Home Phone ( ) |
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E-mail Address |
Business Phone ( ) |
Donor 2
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Name |
Mailing Address |
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Relationship to Donor 1: |
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Date of Birth Age / / |
City State Zip |
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Social Security Number (required) - - |
Home Phone ( ) |
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E-mail Address |
Business Phone ( ) |
Successor Charitable Advisor
– Person appointed to make grant recommendation if Donor(s) are no longer willing or able to.|
Name |
Mailing Address |
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Relationship to Donor(s) |
City State Zip |
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Home Phone ( ) |
Business Phone ( ) |
Section 2: Name Your Foundation. Donors have the opportunity to name their family foundation. A letter, which highlights the name of your family foundation and the name of the donor(s), will accompany grants made from the foundation to charities, unless anonymity is requested.
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Foundation Name |
Section 3: Contribution ($5,000 minimum initial contribution into a component family foundation; or $300 for a "shell" foundation accompanying a charitable trust or major gift plan.) Please refer to the Funding Guidelines to complete the following section, or call (602) 955-4770 for assistance. Note: Securities held for one year or less are deductible at the lesser of cost basis or fair market value.
- Please contact me regarding my desire to set up a charitable trust or other gift plan.
To contribute cash by check or wire: (Please follow the Funding Guidelines.)
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Check: $___________________________________________________________________ (Make payable to The American Foundation.) |
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Wire: $_______________________________________ Bank_____________________________ (Please refer to the Funding Guidelines.) |
Section 4: Foundation Investments (Please check one)
- I would like to make recommendations for the ongoing investment policy and investment selections for my family foundation.
- I request that you consult with ______________________________ at the financial firm of ____________________________
as you develop the investment policy and selections for my family foundation.
- I would like the American Foundation to formulate the investment policy and selections as it feels will best achieve our mutual goals and objectives.
To contribute securities or mutual funds: (Please follow the Funding Guidelines.)
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Firm Name |
Name of Security #2 |
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Broker Name |
Account Number |
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Broker’s Phone ( ) |
Number of Shares |
Approximate Value $ |
Cost Basis $ |
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Name of Security #1 |
Name of Security #3 |
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Account Number |
Account Number |
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Number of Shares |
Approximate Value $ |
Cost Basis $ |
Number of Shares |
Approximate Value $ |
Cost Basis $ |
To contribute stock certificates held in personal possession:
(Please follow the Funding Guidelines.)|
Name of Stock #1 |
Name of Stock #2 |
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Number of Shares |
Approximate Value $ |
Cost Basis $ |
Number of Shares |
Approximate Value $ |
Cost Basis $ |
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Financial Advisor’s Name
__________________________________________________
Tel. ______________________ Fax _____________________
E-Mail ___________________________
Accountant’s Name
__________________________________________________
Tel. ______________________ Fax _____________________
E-Mail ___________________________
Attorney’s Name
__________________________________________________
Tel. ______________________ Fax ______________________
E-Mail ___________________________
Section 5: Acknowledgement & Signature(s).
I acknowledge that I have read the American Foundation’s Turnkey Family Foundation Program booklet and hereby agree with its terms and procedures. I also express my desire to support the American Foundation’s charitable mission and objectives, especially their programs to assist and benefit charities that I recommend. I understand that any contribution, once accepted by the trustees, directors or officers of the American Foundation, represents a completed gift or contribution to the American Foundation and the American Foundation for Charitable Support, and is not refundable to me. I hereby certify that, to the best of my knowledge, all information presented in connection with this application is accurate, and I will promptly notify the American Foundation in writing of any changes. I acknowledge that one percent (1%) of the asset value of my/our foundation will be transferred as a gift allocation to the American Foundation’s operating account annually. (Please attach any additional donor signatures.)
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Donor 1 Signature Date / / |
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Donor 2 Signature Date / / |
Section 6: Referral. How did you learn about the American Foundation?
If a professional advisor referred you, please provide his or her name and daytime telephone.
Advisor Name:_____________________________________ Daytime Phone ( )
Would you like your advisor to receive copies of your statements?
4518 North 32nd Street, Phoenix, AZ 85018
Telephone: (602) 955-4770 * Professionals call: (602) 522-8800 * Fax: (602) 955-4707
Web site: americanfoundation.org E-mail: info@americanfoundation.org
