Dartmouth Alumni - Security Gifting Information – Security Gifting Information

Security Gifting Information - Secure

Thank you for your interest in giving securities to Dartmouth. This online form serves as notification of your intention to make a gift of securities to Dartmouth. Please note that this form cannot be used for restricted stock or stock traded on non-U.S. markets or for the transfer of physical stock certificates. To inquire about such gifts or if your gift involves special instructions, please call the Investment Office at 603-646-3201.

Personal Information

First Name: Required Field

Middle Name:

Last Name: Required Field

Dartmouth Affiliation:

Preferred Class Year:

Preferred Email : Required Field

Your preferred email address is what we use to send email messages to you from the College.

Additional Donor Information (Optional)

First Name:

Middle Name:

Last Name:

Dartmouth Affiliation:

Preferred Class Year (if applicable):

Home Address

Home Address 1:

Home Address 2:

Home Address Care of:

Home City:

Home State/Province:

Home Zip:

Home Country:

Phone:

Gift Designation & Matching Gift Information

Details on how you wish to have the gift allocated: (e.g. DCF, TAG, Thayer Annual Fund, Geisel Annual Fund, etc.)

This gift will be matched.

Enter Security Information Below

Find security information on Yahoo! Finance.

Ticker Symbol:

Security Name:

Number of Shares:

Approximate Value:

Total Cost Basis (not per share):

Additional Security Information (Click Arrow to Expand)

Ticker Symbol

Security Name:

Number of Shares:

Approximate Value:

Total Cost Basis (not per share):

Additional Security Information (Click Arrow to Expand)

Ticker Symbol:

Security Name:

Number of Shares:

Approximate Value:

Total Cost Basis (not per share):

Details for any additional securities can be entered into the Other Instructions box below.

Brokerage Firm

Brokerage Firm:

Other Brokerage Firm:
(if not in list above)

Broker Name:

Broker Phone:

Broker Email:

Other Instructions

Other Instructions:

If you are having trouble with this form or have questions/concerns please email security.gift.processing@dartmouth.edu or call the Investment Office at 603-646-3201 between the hours of 9am and 5pm Monday - Friday.