You can download the form and mail in a physical copy.

 

Download Form

 

 

Or please complete the online form below to establish a donor-advised fund with ProvisionBridge. If you need assistance, call 706.754.6884 or email info@ProvisionBridge.org.

 

    Donor Contact Information
    First Name, MI, Last Name
    EIN or Last 4 of SS#
    Street Address
    City/State
    Zip
    Email
    Primary Telephone Number
    Fund Name
    You may choose a name for your fund and this name will appear on all correspondence including grant checks from your fund (unless you ask to remain anonymous). For example, you may name the fund for yourself, for your family, in memory of someone, or for a particular cause.
    Name of Fund
    Primary Advisor
    First Name, MI, Last Name
    EIN or Last 4 of SS#
    Street Address
    City/State
    Zip
    Email
    Primary Telephone Number
    Additional Advisor
    Does this advisor need to obtain approval from the Primary Advisor?
    First Name, MI, Last Name
    Relation to Donor
    EIN or Last 4 of SS#
    Street Address
    City/State
    Zip
    Email
    Primary Telephone Number
    Succession Plan
    You may name individuals as Successor Advisors to succeed you in advising on the Fund after the death of the Primary and Joint Advisors OR you may elect to name specific charities as the Charitable Beneficiaries of the Fund.
    Charitable Beneficiaries
    (if aggregate percentages to be distributed do not equal 100, then remainder will be treated under the later succession items):
    Charity Name and Identifying Information
    Organization Name
    EIN
    Street Address
    City/State
    Zip
    Web Address
    Phone Number
    %
    % to be distributed upon incapacity of all advisors
    Organization Name
    EIN
    Street Address
    City/State
    Zip
    Web Address
    Phone Number
    %
    % to be distributed upon incapacity of all advisors
    Successor Advisors
    Successor Advisor and Identifying Information
    First Name, MI, Last Name
    EIN or last 4 of SS#
    Street Address
    City/State
    Zip
    Email
    Primary Telephone
    %
    % of Fund value to become separate ProvisionBridge Fund advised by successor advisor upon incapacity of all advisors
    First Name, MI, Last Name
    EIN or last 4 of SS#
    Street Address
    City/State
    Zip
    Email
    Primary Telephone
    %
    % of Fund value to become separate ProvisionBridge Fund advised by successor advisor upon incapacity of all advisors
    Any amounts not allocated will be distributed to the ProvisionBridge Operating Fund upon the incapacity of all advisors.
    Investment Allocation
    ProvisionBridge accounts are invested in money market accounts to provide stability of account value. If you have specific recommendations for investments, please call 706.754.6884 to discuss.
    Initial Contribution
    Please identify the amount of your initial contribution (at least $5,000):
    $
    * Call 706.754.6884 for instructions
    Donor View
    ProvisionBridge is pleased to offer Donor View, which allows 24/7 online access to the find information via our website. Please list names and contact information for anyone with access permission. Normally this list includes the donor, and up to two additional advisors (optional). *Please note that without written permission from the donor, we will not give access to the fund information.
    Person 1
    First Name, MI, Last Name
    Street Address
    City/State
    Zip
    Email
    Primary Telephone Number
    Person 2 (if any)
    First Name, MI, Last Name
    Street Address
    City/State
    Zip
    Email
    Primary Telephone Number
    Person 3 (if any)
    First Name, MI, Last Name
    Street Address
    City/State
    Zip
    Email
    Primary Telephone Number
    Signatures
    I agree to all the terms and conditions included in this application and the Provision Bridge Program Guide. In addition, I am - asking ProvisionBridge to consider and accept my initial irrevocable contribution to the Fund without material restriction or condition. I understand and agree that my role as an advisor is to provide grant recommendations, and that the Internal Revenue Code requires that ProvisionBridge must maintain the ultimate ownership and control over all assets contributed to a donoradvised fund at ProvisionBridge, and any income and growth from such Funds over time. I also understand that ProvisionBridge must maintain unfettered discretion regarding whether to approve my recommendations for distributions from the Fund.
    I understand that no donor-advised fund agreement is formed between me and ProvisionBridge unless and until a representative of ProvisionBridge signs below and delivers the signed application to me.
    Primary Advisor's signature
    Date
    Additional Advisor's signature (if any)
    Date