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Donor Information
Name:
Address:
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City:
State:
Zip:
Phone:
E-mail Address:
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Gifts of Securities
Form
(Note: Fill
out the form below and submit. You will receive a confirmation when you submit the
form.)
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Required Information
Security Information
Name of Security:
Type of Security:
Stock Certificate Number(s):
(Forward stock certificate(s) to OOF)
Delivering Broker:
Approx. Stock Value: $
Broker Address:
Broker Contact Name:
Quantity: Number of Shares
Broker Phone:
Broker E-mail Address:
Please provide Gift Designation below.
(If no designation is indicated, funds will be designated to the Lottie Moon Christmas Offering.)
Gift Designation
(Field Personnel/Region)
Amt: $
Amt: $
Amt: $
Amt: $
Amt: $
Amt: $
Amt: $
Amt: $
Amt: $
Amt: $
Amt: $
Amt: $
Amt: $
Amt: $
Percent (%):
Percent (%):
Percent (%):
Percent (%):
Percent (%):
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Percent (%):
Name of Endowment:
Percent (%):
Percent (%):
Percent (%):
Percent (%):
Percent (%):
Percent (%):
Percent (%):
Project No.:
Project No.:
Project No.:
Project No.:
Project No.:
Project No.:
Project No.:
Project No.:
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God is at work all around the world through . . .
Your Praying • Your Giving •
Your Missionaries • You - On
Mission
“A Southern Baptist Convention
entity supported by the Cooperative Program
and the Lottie Moon Christmas Offering®.”
®Lottie Moon Christmas
Offering is a registered trademark of Woman’s Missionary Union
© Copyright 2005 International
Mission Board.
All rights reserved.
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