Rotary Online Account Request

^{* [required]}

Account Type^*

Individual Account Group Account

Please select account type

Account Holder Information

Required

Name^*	Last Name^* Please check last name
	First Name^* Please check first name
Date of Birth^*
Email Address^*	Please check email

	Address 1
	Address 2
	City
	State	Please check state
	Zipcode	- Please check Zipcode Please check Zipcode extension
	Home Phone	( ) - Please check area code Please check phone prefix Please check phone suffix
	Business Phone	( ) - extension Please check area code Please check phone prefix Please check phone suffix Please check extension
	Cell Phone	( ) - Please check area code Please check phone prefix Please check phone suffix
	Fax Number	( ) - Please check area code Please check phone prefix Please check phone suffix
	Company Name
	CompanyTitle
	Company Address 1
	Company Address 2
	Company City
	Company State	Please check company state
	Company Zipcode	- Please check company Zipcode Please check company Zipcode extension
	Company Website	Please check company website

General: Before your DAF account can be established, you must read and acknowledge the following: I acknowledge that I have read The Rotary Foundation Donor Advised Fund Program Circular and agree to the terms and conditions described therein. I acknowledge that any contribution, once accepted, is an irrevocable gift to The Rotary Foundation Donor Advised Fund. I hereby certify that, to the best of my knowledge, all information presented in connection with this application is accurate, and I will promptly notify The Rotary Foundation Donor Advised Fund of any changes. I acknowledge that The Rotary Foundation has final authority in all investment and grant making decisions. I acknowledge that the DAF privacy policy is available on the web.