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Planned Giving

 

 

 

Stock Transfer Intention Form

It's simple to make a gift of stock to Gaylord Hospital!

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

Steps:

  1. Fill this form out and we will contact you.
  2. 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

   

 

Have Questions About Giving?

Our team is here to help. For more information, please call (203) 284-2881 or contact our team via the button below.