Stock Transfer Information and Form

Information You Need:

Our Broker:

James Ratchford
Wells Fargo Advisors

Account No: 1690585

FBO: Brookstone Schools

DTC No.: 0141

Direct transfer questions to:

James Ratchford

(704) 343-4508

Jim.ratchford@wellsfargoadvisors.com

Information We Need:

Please Complete the Following Information.

Name(s)

Address, City, State, Zip

Daytime Phone Number

Number of Shares

Name of Security

Expected Date of Transfer

Name of Brokerage or Bank

Broker City

Broker State

Broker Name

Broker Phone

This gift is (Choose One) This gift is (Choose One) Fulfilling a pledge For the general operating fund A Partner gift Designated for... (place designation in next box)

Designation (if applicable)

3 + 14 =

Stock Transfer Information and Form

Information You Need:

Information We Need:

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