Stock Transfer Notification

First Name

Middle Initial

Last Name

PFLF ID #

Phone

Address Line 1

Address Line 2

City

State

Zip Code

Broker Information

Date of Transfer

Brokerage Company

Broker Name

Phone

Please use the section below to specify how your gift should be distributed. For each designation, choose whether you want to allocate by Dollar Amount ($), Number of Shares, or Percentage (%). If you are splitting your gift among multiple areas, click "Add another stock" to enter each designation separately.

Stock Information

Stock Name/Ticker Symbol

Allocate this gift using

Dollar AmountNumber of SharesPercentage

Allocation Amount

Gift Designation

Is this a Pledge Payment

YesNo

Pledge Number

Comments

Contact Information