Donor Advised Fund Application

All bold fields are required.

Name of Fund: Example - "The John & Mary Smith Family Charitable Foundation"

This foundation type is: (check one) A personal / family foundation
A company foundation
A foundation for an employee group, club, or other association
  First: MI: Last:
Your name:
Your email address:
For company or employee group foundations, enter company name and company EIN# here:
Company name: EIN:
Please enter a 5-digit numeric personal giver number (PGN) of your choice here:
Use any combination of numbers except 0-0-0-0-0. It must be between 5 and 25 characters long.
Please enter it in twice for verification.   
This number wil be used to verify gift instructions you may make from time to time. Please keep it secure and confidential.
A residence address is required.
Please also submit a business address for company or employee group foundations.
Residence Address:
Address 2:

Business Address:
Address 2:

Do you wish to receive "requests for assistance" proposals by email from ICA pre-screened and approved charities? An example would be a request for aid to help people cope with a natural disaster. Once you have established your foundation you can turn this option "on" or "off" at any time. Default for this option is "no," but we suggest you try it. It can make giving much more personal and involving.

Yes No

Please select a payment method and amount to fund your account.
Payment Options:  Amount: $

After you complete this form you will need to log in to add funds to your account. Please note the email address and PGN used on this form.


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