ADVANCEMENT

Stock Transfer Request

It is important that Dordt College is notified prior to a stock transfer so that we can properly identify, allocate, and acknowledge your gift. Please complete and submit this secure request of transfer form and a development representative will contact you regarding routing instructions. If you wish to discuss your transfer, or if you have any questions, please contact the Advancement Office at 1-800-343-6738 (option #3) or 712-722-6020.

Information About Me

Full Name:
*
Address 1:
*
Address 2:
City:
*
State/Province:
*
Zip/Postal Code:
*
Country:
*
Home Phone:
*
() - (xxx) yyy-zzzz
Email Address:
*

An email confirmation and receipt will be sent upon submission.
Relationship To
Dordt College:

Stock Details:

Number of Shares:
*
Security Name:
*
Ticker Symbol:
*
Expected Date of Transfer:
*

A matching gift will be made by my (or my spouse's) employer.

Broker Information:

Name of Brokerage or Bank:
*
City and State:
*
Name of Broker:
*

(If none, enter N/A)
Phone Number:
*
Brokerage Account Number:
*

I have included Dordt College in my estate plan.

Please Provide Me With More Information On The Following:

Estate: Planned Gifts: Bequests, life income plans, or other planned options

Outright Contributions: Securities

After this form is submitted a development representative will contact you to provide routing instructions and assist you in completing the transaction.

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