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A stock donation is an excellent way to support PSR’s efforts to protect human life from the gravest threats to health and survival.

Please ask your broker to complete this form and forward a copy to PSR so that we can acknowledge your gift and keep your records current.

DATE: ____________________________________________

DONOR: __________________________________________

DONOR’S ADDRESS: _________________________________

DONEE:     Physicians for Social Responsibility

STOCK DESCRIPTION: _______________________________

STOCK QUANTITY: __________________________________

CURRENT VALUE: ___________________________________

BROKER & ADDRESS: ________________________________

__________________________________________________

PSR’s Broker Information:

PSR Contact:
W. Taylor Johnson (202) 587-5235
Broker: Charles Schwab & Co., Inc.
DTC#: 0164 Code 40
FBO: Physicians for Social Responsibility
PSR Acct: 3106-0448
PSR’s Tax ID:
23-7059731