Stocks Notification Form

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Stocks Notification Form
Notify Orchards Children’s Services by filling out the form below

Each time a gift of stock is donated, regardless of the method chosen to deliver a gift of stock, information about the gift for audit and acknowledgment purposes is needed. Please complete the form below and submit for our records.
Name *

First Name Last Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Email *
example@example.com
Does donor wish to remain anonymous?

Yes No
Date of Transfer
What is the approximate amount you would like to donate?
Number of Shares
Name of Security
To which need or service should the gift be directed to?

General Education
Transferring Broker Name

First Name Last Name
What firm is the broker with?
In which state is the firm located?
Firm Phone Number

Area Code Phone Number
Additional Information
Attach a File

Browse Files

Cancel of
If sending a letter or an email is preferred, the following information is needed at the time of transfer:
- Donor’s full name and complete address
- Name and number of securities transferred
- Date of the transfer
- Specific need or service to which gift should be directed, if any.
Send to:

Orchards Children’s Services

Attn: Development
24901 Northwestern Hwy., Suite 500
Southfield, MI 48075
E-mail: rparker@orchards.org
Phone: 248-593-1576

For more information contact rparker@orchards.org
*
Should be Empty: