Charitable Gift Form: Securities Donation

Thank you for making a charitable gift to the Justice Policy Institute(JPI). Please complete the information below to notify the Justice Policy Institute of your gift and help ensure it is processed accurately.

Donor & Securities Information
Name & Type of Securities:*
(e.g.: DELL common stock)
Security Symbol:*
Number of Shares:*
Transfer Date:*
MM slash DD slash YYYY
Donor Name:*
(Individual, Corporation, Foundation)
Donor Address:*
Street Address City State / Province / Region ZIP / Postal Code
Donor Telephone Number:
(to be used only if a question/problem arises in the donation process)
Donor wishes to receive acknowledgement via email:*
- Yes
- No
Donor Email:*
Broker Name:*
Broker Company:*
Broker Contact / Telephone Number:
Justice Policy Institute is a registered 501(c)3 organization and all contributions are tax deductible as permitted by law.

Donor & Securities Information