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| Gift Form |
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This form provides the information necessary to complete the transfer of a gift of stock to EMQ Children & Family Services (Tax ID# 94-1254641) in accordance with the donor's intent. Please complete and sign this gift form. This form may also be used to instruct the donor's broker to electronically transfer a gift of stock. At the time of gift transfer, please fax the completed form to:
EMQ Children & Family Services
Attn: Scott Staub
FAX: 408-364-4034
| EMQ Broker Information: |
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Charles Schwab |
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DTC Number: 0164 |
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EMQ Children & Family Services |
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Account Number: 3026-2852 |
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Charles Schwab |
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| Donor Information: |
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| Name: |
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| Address: |
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| City, State Zip: |
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| Donor wishes to remain anonymous |
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| Securities Gifted: |
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| Date of Transfer: |
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| Name of Security: |
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| Number of Shares: |
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| Name of Security: |
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| Number of Shares: |
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Please specify to which EMQ Program your gift should be directed, if any:
| Area of Greatest Need |
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| Wellspring Children's Assistance Fund |
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| Giarretto Child Sexual Abuse Program |
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| Transferring Broker Information: |
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| Broker Name: |
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| Phone Number: |
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| Brokerage Firm: |
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| Address: |
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| City, State Zip: |
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