Charitable Gift Annuity Illustration Request Form

Please complete this form and click "submit" below. The information you provide does not obligate you in any way to contribute to a gift annuity.

1. I am interested in an illustration for:

(payments made to you and another person for the duration of your lives OR to two other persons for the duration of their lives)


Names and dates of birth of annuitants (those who will receive annuity payments):

First Annuitant:

Yes, please send me action alerts, updates, and special offers to help animals.
Second Annuitant:



State (The HSUS does not offer gift annuities in Alabama, Arkansas, Hawaii, or North Dakota.)

ZIP/Postal Code

Date of Birth

Phone Number
Email address
Amount you are considering (the minimum is $10,000):


Will your annuity be funded with cash or securities?



Preferred frequency of payments?



Do you want to begin payments this year or defer to the future?

If deferring, indicate the year in which you would like to begin payment:


* indicates required field


To enroll, please complete the Humane Legacy online.

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You can download our suggested bequest language for your and your attorney's review.

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