Second National Bank Donation Request Form
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1SECOND NATIONAL BANK
Donation Request Form
Division of The Park National Bank
Second National Bank asks that all organizations requesting donations/support complete this form. We ask that your request be
submitted 2 weeks in advance for consideration. Completion of this form does not guarantee that we will be able to fulfill your
request. Please print or type.
Thank you for filling out this form. Please submit it to any Second National Bank office, or mail to: Second National Bank,
Attn: Vickie Wessling, 499 South Broadway, Greenville, Ohio 45331.
Date: ________________
Date funds are needed: ________________
Organization: _____________________________________________________________________________
Address: __________________________________________________________________________________
City: ______________________________________________ State: _______________ Zip: _____________
Amount Requested: $_________ Total Project Cost: $__________ Range of Donations: $_________________
Request Details:
General Donation/Money
Door Prize
Other Describe ______________________
________________________________________________________________________________________
Is your organization a 501(c)(3) nonprofit agency?
Yes
No
(*If yes, please provide a copy of the IRS determination letter)
Is your organization a customer of Second National Bank?
Yes
No
If no, who is your bank? __________________________
Are any of SNB’s associates affiliated with this effort?
Yes
No
If yes, who? __________________________________
Is this a one- time donation request?
Yes
No
If not, explain: ____________________________________________________________________________
_________________________________________________________________________________________
What is your organization’s primary purpose or mission and who benefits from this? ____________________
_________________________________________________________________________________________
Briefly summarize the program or project for which you are requesting a donation: _____________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Will there be any advertisement and/or promotion featuring Second National Bank?
Yes
No
If yes, please provide details: ________________________________________________________________
_________________________________________________________________________________________
Name and Phone Number of person to contact for more information:
Name: ________________________
Phone: __________________ E-Mail: __________________
Send Payment to: ______________________________________________________________
Name
______________________________________________________________________________
Address
State
Zip
Oct/2013
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