Cerulian (form info)

Impact Account Donors are the individuals or entities that contribute to the initial Account opening and to whom the tax deductible receipt is ascribed. Please list your information below.

SDGIF - Impact Account Form.pdf1738.9KB
  • Legal Name
  • Country of Residence
  • Mailing Address
    • City
    • State
    • Zip
    • Phone 1 (cell / home / business)
    • Phone 2 (cell / home / business)
  • Email
  • Date of Birth

Primary Contact? Yes No

I would prefer to be contacted via:

Phone 1
Phone 2

As relevant, if you wish to include an Executive Assistant or other associate in confidential communications, please also indicate name, contact information, type of relationship and if they are meant to be included in all communications:

  • Name
  • Relationship to Account Donor
  • Phone 1
  • Phone 2
  • Email
  • Date of Birth
The individual above is to be included in all communications
The individual above is to be included in communications I specify prior