Please complete and sign this gift form providing the information necessary to complete the transfer of a gift of stock to Magee Rehabilitation Hospital in accordance with your charitable intent. This form may also be used to instruct your broker to electronically transfer a gift of stock.

Electronic Transfer Instructions

Meg Hardesty
Smith Barney
DTC # 0418
610-542-2939
For the credit of Magee Rehabilitation Hospital
Account Number 55G-09601-11

 

At the time of gift transfer, please fax this completed form to:

Magee Rehabilitation Hospital
Director of Major Gifts
Development Office
FAX: 215-568-3736

Your name and address
(please type or print):

Securities Gifted

Date of Transfer

Number of Shares

Name of Security

Transferring Broker

Name

Telephone

Firm

Address

City, State, Zip Code

Your name as you would like to see it listed in our Annual Report