LEAVE A LEGACY ® Brochures
  1. Nonprofit participants may order 500 brochures - absolutely free while supplies last. 

  2. Brochures will be distributed to one location in each of the seven regions of the state. Please indicate which one of the following distribution sites is closest to your organization.  Participants may pick up brochures at one of the designated regional locations or they may choose to have the material shipped directly for a pre-paid charge of $15.

Please provide the following information:

q

Please ship the brochures to the address below.  I’ve enclosed payment of $15 for shipping and handling.  

q

I will pick up the brochures in the region closest to me (please circle):
___Fairfield County Region ___Greater Hartford Region  ___New Haven Region ___Middlesex County Region
___Northeast Region ___Northwest/Waterbury Region  ___Southeast Region

 

Brochure Order Form

Please complete and return the entire participation form to the
Planned Giving Group of Connecticut

Organizations ordering more than 500 brochures must complete the entire order form and are asked to contribute to the cost. These orders cannot be filled without payment for each brochure over 500 pieces. Please remember to include your nonprofit tax-exempt number.

 

q

We will need ______ copies of the LEAVE A LEGACY®  2003 brochure.
Name
 
Total # of pieces – 500 =              x .10 =  
$
Organization
 
Shipping and Handling ($15)   
$
Street
 
Subtotal   
$

City/State/Zip

 
Add 6% sales tax if applicable    
$
Phone
 
TOTAL ENCLOSED   
$
Fax
 
Sales tax exempt # 
                               
Email
 
   

Fax your completed order form to (860) 525-5088 or send the order form and check/money order to: 
LEAVE A LEGACY
® CONNECTICUT
c/o Planned Giving Group of Connecticut
77 Rumford Ave., Suite 3B, Waltham, MA  02453
Ph:  (781)-647-7004   Fax: (781) 647-7222   Email: pggct@camihq.com    
Web: http://www.leavealegacyct.org