Electronic Stock Transmittal Form • Northeastern Fund

Please complete and submit the form below if you plan on making a gift of stock

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First Name*

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Last Name*

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Street Address*

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Street Address 2

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City*

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State*

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Zip Code*

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Email Address*

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Phone*

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Class Year

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Broker Name*

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Broker Phone*

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Name of Stock*

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Number of Shares*

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Type of Stock*

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Intended Date of Transfer*

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Special Instructions

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To have a gift of stock electronically transferred:

1. Complete and submit the online form, or mail a transmittal letter from your broker to:

Att: Noreen Gallagher
Assistant Director, Gift Services
Northeastern University
402 Columbus Place
360 Huntington Avenue
Boston, MA 02115
617-373-2793 (P)

Alerting Northeastern that the stock transfer is taking place allows us to properly identify, direct and acknowledge your gift.

2. Instruct your broker to transfer shares to Northeastern University at:

Northern Trust
50 South La Salle Street
Chicago, Illinois 60603 USA
Depository Trust Company (DTC): 2669
AGENT BANK #20290
INSTITUTIONAL ID #26724
NORTHEASTERN ACCOUNT: 44-71943
Att: Courtney L. Cooper: tel: +1 312-557-1926 email: cc254@ntrs.com
Reference: Donor Name (your name)

If your broker has questions about making an electronic gift of securities, please have your broker contact Noreen Gallagher, n.gallagher@neu.edu, 617-373-2793.

Note: It is important that your broker does not sell the securities and send us a check. If the broker does this, the tax advantages of making a gift of appreciated stock may be eliminated.