Donation Application

First Name

Middle Name

Last Name

*X Required
Organization you represent:

*X Required
Persons relationship with organization:

*X Required
Describe your request:

*X Required
Does the organization have a current account relationship with the bank: Does the organization have a current account relationship with the bank:
- Yes
- No
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*XRequired
Has the bank received donation request from you in the past? If so, when:

*X Required
Is this a one-time request? Is this a one-time request?
- Yes
- No
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*XRequired
How much is the request:

*X Required
What are the benefits to the individual/communities and how many people will this donation benefit:

*X Required
Does the organization provide community services primarily for low to moderate income individuals: Does the organization provide community services primarily for low to moderate income individuals:
- Yes
- No
VALUE+-
*XRequired
Organization's Tax ID Number:

*X Required
Make checks payable to (name):

*X Required
Send check to: (Address of Organization)

Address 2

City

State

Zip Code

*X Required
Please attach any additional materials that you would like us to review along with this application:

*X Required
A committee will review your request, and if approved, a check will be issued in 14 days. We may request a photo of our donation. By submitting this application, you are giving consent for the photo to be published on our website and social media outlets.
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