stock-information

To start, please identify the stock, quantity of shares, and organization receiving the donation.

Stock Symbol:*

Quantity:*

Personal Information

First Name*

Last Name*

Date of Birth*

Phone Number*

Email*

Email Confirm*

Address*

City*

State*

Zip code*

Create your Brokerage account

Brokerage Firm*

Brokerage Firm Contact Information

Brokerage Firm Name:*

Address:*

City:*

State:*

Zip code:*

Phone Number:*

Brokerage Firm Fax Number:*

Account Name:*

Account Number:*

Is this a Joint Account / Co-Trustee Account?*

Yes

No

Name Of Joint Account Holder/ Co-Trustee:*

Social Number*

Save brokerage firm details to your Stock Donator account?

Yes

No

Please confirm your donation information:

Stock Donation Details:

Quantity

Stock Symbol

Receiving organization

Personal Information:

Name:

Email:

Brokerage Information:

Brokerage Firm:

Account Name:

Account Number:

Joint Account:

Name Co-Trustee:

Donation Preference:*

In my name

Deliver it anonymously

Donation Purpose:*

Discretion of Org

Specific Purpose Donation:

Type requested use of donation proceed.

Your Signature *

Clear

(*Please draw signature with your mouse or on a touch screen with your finger)

Joint Account Holder’s Signature *

Clear

Confirmation:*

I have read and agree to the stated terms and conditions.

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Stock Donator

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Stock Donation to Youth Power Coalition

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To start, please identify the stock, quantity of shares, and organization receiving the donation.

Personal Information

Create your Brokerage account

Brokerage Firm Contact Information

Please confirm your donation information:

Stock Donation Details:

Personal Information:

Brokerage Information:

Thank you for making a stock donation using Stock Donator!

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