Authorized Party Agreement

You have been designated as an Authorized Party with permission to view and obtain confidential information about fund balance, contribution and grant history, and financial information by phone, fax, mail or online for the fund below during the Fundholder’s lifetime.

Kindly provide the information requested below to begin using the fund.
Name of Fund*
Fund Number
Name
First Last
Date of Birth*
MM slash DD slash YYYY
Email*
Preferred Address*
- Home
- Business
Home Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Business Name
Business Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Preferred Phone*
- Home
- Business
- Cell
Home Phone
Business Phone
Cell Phone
Relationship to Fundholder(s):*
Acknowledgement*
- I acknowledge that I have read the Policies and Procedures booklet and agree to its terms and/or conditions. I certify that the information provided herein is accurate and complete and I will notify the Jewish Communal Fund of any changes.
Digital Signature*