Broker Information:
Broker Name: ___________________________________________________________________________
Broker Telephone: _____________________________ Broker E-mail: _____________________________
Re: Electronic Transfer of Securities for Charitable Purposes
Transfer from:
Account #: ____________________________________ Account Name: ___________________________
Donor’s Name (Please Print): _____________________________________________________________
Securities to be Donated:
Company Name: _________________________________ # of shares: ___________________________
CUISP#: ________________________________________
Receiving Institution Information:
Ameriprise Financial
500 Damonte Ranch Parkway S- 735
Reno, NV 89521
University of Nevada, Reno Foundation
Tax ID# 94-2781749
A/C# 610485245133
DTC# 0756
Financial Advisor: David Horton
Phone: (775) 829-7210
1-800-862-7919 Fax 775-829-7219 david.d.horton@ampf.com
Donor/Client:
Name: __________________________________________ Daytime Telephone: ____________________
Address: _____________________________________________________________________________
Gift
City: __________________________ State: ____________ Postal Code: __________________________
Designation:
Top Priorities of the University of Nevada, Reno Foundation
Specific Fund: ____________________________________ Fund #: _______________________
If you have any questions regarding this form please contact Tammy Koszuth or Emelita Weldon at:
University of Nevada Reno, Foundation
Development and Alumni Relations
Morrill Hall Alumni Center / Mail Stop 007
Reno, NV 89557-0007
Telephone: (775) 784-1587 Fax: (775) 784-1957
E-mail: giving@unr.edu