Stock Transfer Notification Form

Thank you for completing this notification form to let Viterbo University know of your intent to transfer a gift of stock.

You will be required to initiate the transfer with your broker and complete any necessary forms with your financial institution.

* Required fields

Personal Information

Donor Name *

Address

Phone *

Email Address *

Gift Information

What would you like your gift to impact?

Viterbo Fund

Scholarships

Mission

Programs

Student Success

Facilities

Gift Type:

Stock

Mutual Fund

Charity's Information

Charity's Legal Name: *

Charity's Tax ID: *

Charity's Address: *

Charity's Email Address: *

Charity's Phone Number: *

Charity's Broker Institution: *

Charity's Broker Institution Address: *

Charity's Account Name: *

Charity Brokerage Account Number: *

Charity's Electronic Transfer Number (DTC): *

Instructions for transfers by certified mail - If you hold securities in certificate form, you will need to mail two envelopes separately to complete your gift. In the first envelope, place the unsigned stock certificate(s). In the other envelope, include a signed stock power for each certificate. You may obtain this power from your broker or bank. Please remember to use certified mail.

Please note: This notification form is not a receipt for your charitable donation. We will send you an acknowledgement after we have received your gift. The value of a charitable gift of stock is determined by the average between the high and low stock price on the date of the gift. Mutual fund shares are valued using the closing price for the fund on the date of the gift. The date of the gift is the date the charitable organization receives the asset. Consult your broker for more information on the timing of the transfer.

First Name

Last Name

Comments

Thank You

Thank you for your interest in supporting Viterbo University.

One of our gift planning representatives will contact you to discuss your charitable plans.

“We wanted to start paying it forward right away. Our scholarship is designed for people with mortgages and kids who need to keep their families going under the stress of other priorities.”

Barry + Maria Stahl
Barry and Maria Stahl Family Nursing Scholarship
“I had the great fortune of attending Viterbo, and scholarship support allowed me to have that amazing experience. Now I want to help other students achieve their potential and find out who they want to become.”

Dean Yohnk
Dean Yohnk First Generation Scholarship
“We have been very blessed in our lives and we thought it was a good time to give back. We couldn't think of a better way to help young people move forward in their lives and to show appreciation to Viterbo University for all it has given us.”

Joe + Lori Dunham
Joseph and Lori Dunham II Capital Market Business Scholarship

Your Legacy... Our Gratitude

Stock Transfer Notification Form

Personal Information

Gift Information

Charity's Information

Thank You