Stock Transfer Request Form printable pdf download

Stock Transfer Request Form

TOCK

RANSFER

EQUEST

ORM

Send original to Donor’s broker; send copy to Calvin Presbyterian Church

DONOR INFORMATION:

Name:

Telephone:

ACCOUNT NUMBER: ________________________ Email: _________________________

Donor’s

Name:

Broker:

Title:

Firm:

Phone:

Fax:

By copy of this letter, I am directing you, my stockbroker, to electronically transfer

shares of common stock in

, stock symbol

as a charitable contribution to the following, a 501(c)(3) charitable organization registered with

Washington’s Secretary of State:

CALVIN PRESBYTERIAN CHURCH

Taxpayer ID: 91-6014734

Phone: (206) 542-6181

Please send these shares to:

BROKER:

SCOTTRADE, INC

DTC NUMBER:

0705

Account name: Calvin Presbyterian Church

Account number: 20157805

Telephone: (425) 775-3380

Broker: Scottrade-Lynnwood

Donor Signature:

Date:

Donor Signature:

Date:

(If joint account)

For donor use only:

SEND COPY TO:

Calvin Presbyterian Church

Phone: (206) 542-6181

Robin Carlstrom, Finance Coordinator

Fax:

(206) 542-7023

18826 3

Ave NW

Shoreline, WA 98177

How would like these funds used?

P:My Documents on PInstructionsStock Transfer Form.doc

Revised 2006-12

Stock Transfer Request Form

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