IRA Qualified Charitable Distributions Gift Information

Gift Information Form for an IRA Qualified Charitable Distribution (QCD)

If you initiate your IRA QCD directly with your custodian, please complete the following form so we can connect the mailed gift to your record. The team will follow-up with an acknowledgement letter for your files.

First

Last

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Telephone Number

Email Address

Confirm email

Financial Institution Name

Estimated Gift Amount

Check Number (Optional)

Please send donations to: Partners In Health, PO Box 996, Frederick, MD 21705-9942