200 Kennedy Memorial Drive
Waterville, ME 04901
Letter of Authorization To Broker
Broker’s Name: _______________________________
Dear _____________________ :
Please transfer to the Inland Foundation the following securities:
The Inland Foundation prefers that the securities be electronically transferred to the Foundation’s account at A.G. Edwards in Waterville, ME.
Feel free to contact Marc A. Pitman, Director of the Inland Foundation, at (207) 861-3377.
Firm: A.G. Edwards
DTC # 0-201
For the benefit of Inland Foundation Account #xxxxxxxx
Inland Foundation Federal ID # xx-xxxxxxx
Contact: Rxxxr Kxxxxx, 222 Kennedy Memorial Drive, Waterville, ME 04901
This gift is for the benefit of the following department, program, fund, or project:
Signature Account #
Name (Please Print) Phone
cc: Inland Foundation (mail or fax: 207-861-3039)
Broker Authorization Form (pdf)
Here is a PDF of a simple broker authorization form that you can use in making your own.
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