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Donation or Gift Request Form

Please review our Donation Policy before submitting your request.

*Required Field
Name of Organization:*
Address:*
City:*
State:*	[select state] Alabama Arizona California Colorado Connecticut D.C. Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming     Zip:*
Contact Person:*
Phone:*
Fax:
Email*
Federal Tax ID Number:
Local Branch Requesting Donation Form:*
City or Counties Served:
Please Describe Your Request:
Please attach supporting documents: (Must be a .doc or .pdf file, under 2mb)
Does the organization have a current relationship with the Bank?*	Yes No
If yes, what type(s) of account(s)?	Checking Savings Loan Money Market Investment CD Trust Services Other
Who is your contact person at the Bank?
Has the bank received this request in the past?*	Yes No    If yes, when?*    How much?* $
Request for:*	Monetary Support Item Donation Both
Amount Requested:*	$
Date funds are needed by:*	(minimum of two weeks from date presented to Bank)
If a monetary donation is being requested, who should the check be made payable to?*
Item Requested:*
Items to be used for:*	Live Auction Door Prize Raffle Other:
Branch where items will be picked up?*	Date:*      Time:*
Do You Need an Ad?*	Yes No      Ad Color: Black & White Color
Do You Need a Logo?*	Yes No      Logo Color: Black & White Color
Size:*	W: "   H: "
Ad / Logo File Format:*	PDF JPG TIF GIF
Email address where ad needs sent:*
Date ad is needed by:*
Please attach last years' ad if possible (Must be a .pdf, .jpg, .gif, or .tif file, under 2mb)
Do you need a CNB Banner?	Yes No
Is there an opportunity for the CNBear to participate in the event?
Does this organization fund/sponsor other nonprofits? If so, which ones?
What are the benefits to the organization if this request is approved?
How will the Bank be recognized for the donation?
Is there a photo opportunity?	Yes No
What are the benefits to the community if this request is approved?
*Security Code: