Stock Gift Form

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DONATE TO LOCAL DISASTER RELIEF HERE!
 

 

 

 

Please complete this gift form, copy and paste into an email. Or print this form to fax or mail  it to the American Red Cross at the following address:

    American Red Cross-Hoosier Hills Chapter 
    Attn: Gift Planning
    2119 29th Street
    Bedford, IN  47421
    E-mail: chapter@hhredcross.org 
    Phone: 1-812-275-5162
    Fax: 1-812-275-5120

     

    Donor's Name:
    Donor's Address:
    City:
    State:
    Zip Code:
    E-mail:
    Donor wishes to remain anonymous
    Securities Gifted
    Date of Transfer
    Number of Shares
    Name of Security
    Number of Shares
    Name of Security
    Specific HH American Red Cross Program to Which Gift Should Be Directed, if Any:
    General Fund
    National Disaster Relief Fund
    International Response fund
    Local Chapter:
    Other:

      e.g. specific disaster (Balkan Relief, Hurricane Georges),
      Red Cross Museum, Biomed, etc.
    Transferring Broker
    Name
    Firm
    Telephone
    City, State

     

                    

 
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Last modified: November 2, 2006