Thank you for your generation donation of stock.

Dancing With Chicago Celebrities does not receive any information that identifies you as the donor when your stock is transferred. Therefore, we kindly ask that you alert us in advance about the stock and number of shares you plan to donate. Please notify us of your gift by calling 630-699-6327 and leave a confidential voicemail or by completing this form.
 
IF YOU HAVE ANY QUESTIONS PLEASE CONTACT US AT info@amdwcc.org or call us at 630-699-6327

Forms or other required information can be sent to:
Dancing With Chicago Celebrities
Attn: Jane Melvin
116 West Illinois, Chicago, IL 60654

Please provide the following donor information:

Question Title

* 1. Please provide the following donor information:

Stock Issuer

Question Title

* 2. Stock Issuer

Number of Shares

Question Title

* 3. Number of Shares

Estimated value of shares *

Question Title

* 4. Estimated value of shares *

If your donation is in support of an individual's fundraising efforts, please let us know whom we can thank:

Question Title

* 5. If your donation is in support of an individual's fundraising efforts, please let us know whom we can thank:

If your gift is in honor of or a tribute to someone, please list their name here:

Question Title

* 6. If your gift is in honor of or a tribute to someone, please list their name here:

Would you like a copy of our IRS tax exempt letter for your records?

Question Title

* 8. Would you like a copy of our IRS tax exempt letter for your records?

Would you like a copy of our W-9 form for your records?

Question Title

* 9. Would you like a copy of our W-9 form for your records?

Additional comments:

Question Title

* 10. Additional comments:

T