Stock Donation Intake Form | Stormy Butterfly

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Stock Donation Intent Form

Thank you for your generous support. Please complete this form to help us track and acknowledge your gift accurately.

Full Name

Email Address

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Country

Stock

Ticker Symbol

Number of Shares

Estimated Value (Optional)

Brokerage Firm (Sending)

Expected Date of Transfer

I prefer to remain anonymous

Thanks for submitting!

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