Stock Donation Form

The completion of this form will inform the organization of your intent to make a Stock Donation.

Donor Information

DONOR NAME

First Name

DONOR LAST NAME

Last Name

EMAIL

PHONE

ADDRESS

Street Address

Address Line 2

City

State

Zip Code

Broker Information

COMPANY

POINT OF CONTACT

First Name

POC Last Name

Last Name

Details

GIFT INFORMATION *

Name of Security

Ticker

# of Shares

Estimated Value

Name of Security

Ticker

# of Shares

Estimated Value

Name of Security

Ticker

# of Shares

Estimated Value

Name of Security

Ticker

# of Shares

Estimated Value

IS THIS DONATION FROM A TRUST?

YesNo

TRUST

EXPECTED TRANSFER DATE

Contact Information