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Stocks & Securities Form

Thank You For Your Gift

Please complete this form to notify us of your gift. We will contact you to provide the account information.

Name & Type of Securities*
Number of Shares*
Transfer Date*
MM slash DD slash YYYY
Gift Designation*
Donor Information
Donor's Name*
First Last
Donor's Phone*
Donor's Email*
Donor's Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Broker Information
Broker's Name*
First Last
Broker's Company*
Broker's Phone*