Bequest intention form

Please use this form to share details about your future gift intentions to the University of Rochester that you have included in your estate plan. Any information about your gift will remain confidential, and we understand that you may change your plans at any time.

Thank you for your generous bequest to the University of Rochester.

* Did you gift a percentage of your estate or a set dollar amount?
	Percentage of estate
	Dollar amount

* What percentage of estate or dollar amount did you gift?

* What is the purpose of your gift or area of the University you wish to support?

* Full name:
* Occupation:
* Birthdate:
* Address:
* City:
* State/Province:
* Postal Code:
* Country:
* Phone:
* E-mail:

Questions or Comments:

*All fields marked with the asterisk symbol (*) are required.

Back

Address for US Mail:
University of Rochester
Box 278799
Rochester, NY 14627-8799

Address for deliveries requiring a signature:
(FedEx, UPS, etc...)
University of Rochester
Office of Trusts, Estates & Gift Planning
300 East River Road, #117
Rochester, NY 14623

Phone: (800) MELIORA - (585) 275-8894
Fax: (585) 276-1986
Email: giftplanning@rochester.edu

University of Rochester
Federal Tax ID# 16-0743209

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