Stock Donation Notification Form

Scalpel At The Cross will issue an acknowledgement letter of your contribution once we have been informed by Charles Schwab that the transfer has been completed. 

To ensure the proper receipt, please provide the following information so we can identify and acknowledge your gift.

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First Name *
Last Name *
Phone *
E-mail *
Street Address *
City *
State *
Zip Code *
Name of Security / Stock Ticker Symbol *
If transferring multiple securities, please list each one.
Approximate Number of Shares *
If transferring multiple securities, please indicate the number of shares along with its corresponding stock ticker symbol.
Expected Date of Transfer *
MM
/
DD
/
YYYY
Transferring Broker Name *
Transferring Broker Firm *
Transferring Broker Telephone
 *
Specified fund. *
Please apply my donation to the following fund(s). If selecting multiple, please include instructions in the comments below.
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