Charitable Donation Request Form (Page 2 of 2) in pdf

Charitable Donation Request Form Page 2

Please Tell Us About the Requested Donation

Name and brief description of the program or project for which you are requesting funding and how the

community will benefit from it:

______________________________________________________________________________

Amount

# of people

of request: ____________

directly benefiting: __________

Age group (youth, seniors, etc.)

Amount of annual

served: ___________

budget: ____________

% of $ received going towards

fundraising & administrative costs: _____________

program beneficiaries: ______________

Will Dean Bank be recognized for this donation? If so, how?

______________________________________________________________________________

Key Information:

Date of event/program:

_______________________

Date by which funds need to be received:

_______________________

Date by which artwork, logo or banner needs to be received: _______________________

Where to send or e-mail artwork, logo or banner to? ______________________________

Your application will not be considered without the following items:

Copy of 501(c)3 classification from IRS

Projected budget for program or project, showing sources of funding and expenses

Please allow Dean Bank at least two weeks to process your request.

If approved, you will receive your funding check by mail, unless

requested otherwise.

Please send request to:

Dean Bank

Attn: Michael Carroll

Assistant Vice President

Marketing & Communications

P.O. Box 307

Franklin, MA 02038

E-mail:

or fax to (508) 541-5687

_________________________________

________________________________

Signature of Applicant

Date

Charitable Donation Request Form Page 2