Stock Transfer Intention Form

It's simple to make a gift of stock to the Roswell Park Alliance Foundation!

We will receive basic information about your intentions, so we can lend any assistance and credit your gift when it arrives.

Steps:

Fill this form out and we will contact you.
Make sure you contact your broker to initiate the actual transfer.

Notes:

Our office can help you walk through the possibilities for gift designations.
For security reasons, we do not ask for your account number over the Internet.

Bolded items with an asterisk (*) are required fields.

Donor Information
Name*
Address 1*
Address 2
City*
State*
Postal Code
Country
E-Mail*
Home Phone*
Broker/Stock Information
Brokerage/Financial Institution Name*
Broker/Contact Name*
Broker/Contact Phone*
Broker/Contact E-mail
Broker/Contact Fax
Anticipated Transfer Date*
Stock Name*
Number of Shares*
Special Instructions to Broker

Gift Designation Information
My gift is available for the unrestricted use of Roswell Park. I would like to designate my gift for a specific use.

Contact Us

Planning your estate and legacy for future generations, including your charitable interests, takes careful evaluation. Consulting with the appropriate professionals can assist you in making your plans to benefit Roswell Park.

Stock Transfer Intention Form

Donor Information

Broker/Stock Information

Special Instructions to Broker

Gift Designation Information

Contact Us