Charitable Donation Request Form printable pdf download

CHARITABLE DONATION REQUEST FORM

All of the following information is required in order for Southbridge Savings Bank to consider your request.

Organization: ____________________________________________________ Date: ______________________

Organization’s Contact Person: ____________________________________________Title: _______________________________

Mailing Address: ______________________________________ City: ____________________ State: ______ ZIP: ____________

Phone Number: _______________________________ Email Address: _________________________________________________

Please make sure your proposal includes the following information:

A description of your organization, including its mission and major accomplishments

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A copy of the letter from the IRS stating your organization’s 501(c)(3) status, if applicable.

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A list of key staff and titles and current Board of Directors including officer status, if applicable

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Contact person’s relationship to the organization:

Employee ______

Volunteer_______

Paid Worker ______

Fund Raiser ______

What services are rendered by your organization? _________________________________________________________________

________________________________________________________________________________________________________

What percentage of the donation will be used to help low to moderate income individuals or families? ______________________

How will this donation be used? ____________________________________________________________________________

________________________________________________________________________________________________________

What kind of advertising/signage and recognition will Southbridge Savings Bank receive, if any? _______________________________

________________________________________________________________________________________________________

Are there any other financial institutions donating at this time? If so, please list.____________________________________________

Why type of contribution are you seeking? (check one)

_____ Monetary $_______________ (please be specific)

_____ Southbridge Savings Bank Promotional Item(s)

Desired Items: _________________________________________________________

By what date do you need the contribution? ______________________________________________________________________

Please submit complete proposals no less than 30 days before contribution is needed. Incomplete or late proposals may not be considered.

Does your organization do business with Southbridge Savings Bank? _______________________________

To whom should the check be made payable? ___________________________________________________________________

Signature of Organization’s Officer: ______________________________________________________________________________

Within 30 days following the event, please provide a letter or program showing how funds were used and the benefits the Bank received.

Internal Use Only

Req. Number: _______________

Date of Review: _______________

Approved: _______________

Denied: _______________

Conditions:

Charitable Donation Request Form