Donation Request Form
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1Donation
R equest
F orm
Mission of the Organization:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Date of Request:_____________________ Name Of Organization: __________________________
Requested By: ________________________
Primary Contact Person: ________________
Title: _________________________________________
Officers of Organization:
President:____________________________
Vice President: _________________________________
Treasurer:____________________________
Secretary: _____________________________________
Board members:_______________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Organization Address: __________________________________________________________________
Phone Number: Fax/Email _____________________________________
Are any bank employees part of this organization?____________________________________________
Brief History of organization:_____________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Brief explanation of organization’s objectives: _______________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
Reason/event donation is requested: ______________________________________________________
_____________________________________________________________________________________
Date of event:_______________________ Date gift is needed by:___________________________
Who will the gift benefit? ________________________________________________________________
What percentage of the gift will be used for the event? ________________________________________
What percentage of the gift will be used for the organization’s administrative purposes? _____________
Have we made previous donations to this organization? ___________If so, when? __________________
Does the organization have a relationship with the Bank?______________________________________
Please
f orward
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S ection
5 01
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e xempt
number,
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a pplicable.
S end
a ll
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i nformation
e ither
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m ail
t o:
Profile
B ank
PO
B ox
1 808
Rochester,
N H
0 3866-‐1808
Fax:
6 03-‐332-‐2519
Attn:
J eanette
P oulin,
A VP,
M arketing
a nd
S ales
D irector
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Parent category: Business