Untitled Document

Stock and Securities Donations
for Alpha Church, Inc

In supporting the church with your gifts you may desire to give appreciated stock
to Alpha Church, Inc.
Please mail or fax this completed form to:

TD Waterhouse
Attention: Mr. Vijay Kapur, manager
8989 North Scottsdale Road
Scottsdale, AZ 85253
Fax: (480)-315-0396
Tel: (800)-934-4448
DTC No. 0044

Name and Type of Securities/ Number of Shares/ Trans. Date

Donor's Name (If anonymous, see your Broker)

Donor's Street Addrress

Donor's City/State/Zip

Donor's phone number (This will only be used if a question arises
or a problem occurs in the donation process.)

Broker's Name

Broker's Company

Broker's Phone Number

After Alpha Church receives this form and the donation of securities is confirmed by our broker, the fund development staff will issue an official acknowledgment letter to the donor. This letter will indicate the number and type of shares received and the date the stock was converted into a gift (day when record ownership of stock was transferred to Alpha Church, or the stock was unconditionally delivered to Alpha Church). Your contributions are tax deductible to the extent provided by law; your tax advisor will inform you as to their deductibility by you. Alpha Church is a 501(c)(3) not-for-profit church corporation.
Alpha Church, P.O. Box 21131, Albuq., NM 87154 tel. 505-275-7424