Donate Marketable SEcurities

You can easily donate marketable securities with the following information.

Broker	Morgan Stanley Smith Barney LLC
DTC Clearing Number	0015
For Benefit of	Medical Debt Resolution, Inc.
Client Account Number	011-042454-549

After you’ve donated marketable securities, please additionally fill out the following form:

Name(Required)

First Name Last Name

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email(Required)

Stock Ticker Symbol(Required)

Number of Shares(Required)

Date of Transfer(Required)

Fund Allocation(Required)

General Operating Fund

General Medical Debt Relief Fund

General Operating Fund Amount(Required)

What percent of your donation should go to the general operating fund?

General Medical Debt Relief Fund Amount(Required)

What percent of your donation should go to the general medical debt relief fund?

Hidden

Total Percent(Required)

Please make sure your fund allocation amounts add up to 100% in total.

Name

This field is for validation purposes and should be left unchanged.