DONOR INFORMATION WORKSHEET
Donor 1 Name __________________________________________________________________________
Donor 1 Date of Birth ______________________ Soc. Sec. No. _________________________
Donor 2 Name __________________________________________________________________________
Donor 2 Date of Birth ______________________ Soc. Sec. No. _________________________
Company or Foundation (if applicable) _________________________________________________
Street Address ________________________________________________________________________
City, State, Zip_______________________________________________________________________
Alternate Address______________________________________________________________________
City, State, Zip ______________________________________________________________________
Telephone __________________________________ Fax ___________________________________
E-Mail __________________________________________________
Financial Advisor's Name ______________________________________________________________
Financial Advisor's Address ___________________________________________________________
City, State, Zip ______________________________________________________________________
Tel. ______________________ Fax _____________________ E-Mail _________________________
Accountant's Name _____________________________________________________________________
Accountant's Address __________________________________________________________________
City, State, Zip ______________________________________________________________________
Tel. ______________________ Fax _____________________ E-Mail _________________________
Attorney's Name _______________________________________________________________________
Attorney's Address ____________________________________________________________________
City, State, Zip ______________________________________________________________________
Tel. ______________________ Fax ______________________E-Mail _________________________
Successor Charitable Advisor's Name ___________________________________________________
(Person appointed to make distribution recommendations if donor(s) are no longer
willing or able to.)
Street Address ________________________________________________________________________
City, State, Zip ______________________________________________________________________
Telephone ______________________________ Fax _______________________________________
Signature Donor 1 _______________________________________________ DATE ______________
Signature Donor 2 ________________________________________________ DATE ______________
THE AMERICAN FOUNDATION
4518 N. 32nd Street, Phoenix, AZ 85018
Telephone: (602) 955-4770 ¨ Fax: (602) 955-4707
E-mail: info@americanfoundation.org ¨ Web site: americanfoundation.org