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Holy Cross Health Foundation

Online Gift Annuity Illustration Request
We respect your privacy. Information collected here will be kept strictly confidential. It will not be sold, rented, loaned or otherwise disclosed, and it will not be used in ways to which you have not consented.



* Indicates required information
*Yes, I would like to arrange a gift annuity based on a gift of (dollar amount): * 
This gift will be in (select one): 


The estimated cost basis of the securities is (dollar amount): 
Type of Annuity (select one): * 


Individual Annuity  
Please complete the following information for the sole or first annuitant. 
First Name * 
Last Name * 
Address * 
City * 
State * 
ZIP * 
Birthday * 
Email Address * 
Telephone Number * 
Joint/Two Lives Annuity 
Please complete the information for the second annuitant. 
First Name 
Last Name 
Address 
City 
State 
ZIP 
Birthday 
Telephone 
Relationship of this annuitant to donor/first annuitant: 
Authentication * 

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Holy Cross Hospital | 1500 Forest Glen Road, Silver Spring, MD 20910 | 301-754-7000