Stock Transfer Intention Form

It's simple to make a gift of stock to Catholic Health or one of our entities!

We will receive basic information about your intentions, so we can lend any assistance and credit your gift when it arrives.

Steps:

Fill this form out and we will contact you.
Make sure you contact your broker to initiate the actual transfer.

Notes:

Our office can help you walk through the possibilities for gift designations.
For security reasons, we do not ask for your account number over the Internet.

Bolded items with an asterisk (*) are required fields.

Donor Information

Name*

Address 1*

Address 2

City*

State*

Postal Code

Country

E-Mail*

Home Phone*

Broker/Stock Information

Brokerage/Financial Institution Name*

Broker/Contact Name*

Broker/Contact Phone*

Broker/Contact E-mail

Broker/Contact Fax

Anticipated Transfer Date*

Stock Name*

Number of Shares*

Special Instructions to Broker

Gift Designation Information

My gift is available for the unrestricted use of Catholic Health or one of our entities.

I would like to designate my gift for a specific use.

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What can we help you find?

Stock Transfer Intention Form

Donor Information

Broker/Stock Information

Special Instructions to Broker

Gift Designation Information

Explore More Gift Options

Will or Trust →

Appreciated Securities →

Life Insurance →

Retirement Plan →

Real Estate →

Personal Property →

Donor-Advised Fund →

Mineral Rights →

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Urgent Care When You Need It Most

At Catholic Health, everything is designed around you. And made for Long Island.