Securities Delivered Electronically
(broker name)
(address)
(city, st zip)
DTC Number: (DTC #)
Account Name: (account name)
Tax ID# (EIN): (EIN)
Account Number: (account #)
Account Number: (account #)
Please instruct your broker to include your name in the delivery instructions.
So that we are able to ensure proper acknowledgment of your gift for income tax purposes, we ask that you notify us in advance of any electronic transfers of securities. You may notify us online by e-mailing us at (e-mail) or you may complete the Gift Notification Form and forward it to us at the address referenced above. The information you provide should include a description of the securities donated, the number of shares of stock or face amount of bonds, your name, address, phone number and e-mail address if available.
