Community, Non-Profit Donation, Grant Request Form

Organization Name:

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Address:

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Address (cont):

City:

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State:

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ZIP Code:

*

Contact Person:

*

Phone:

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Fax:

Email:

*

City or Counties Served:

Please Describe your Request:

*

Please Attach Supporting Documents:

Does the organization have a current relationship with the bank?

YesNo

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If yes, what type(s) of accounts?

Has the bank received this request in the past?

YesNo

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If yes, when?

Request for:

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Date funds are needed: (Minimum of two weeks from date presented to Bank):

*

If monetary donation is being requested, who should the check be made payable to?

*

Item requested:

*

Item to be used for:

*

Description:

Do you need an ad?

B/WColorNo

*

Ad height:

Ad width:

Do you need a logo?

B/WColorNo

Ad/logo format?

Email where ad needs to be sent:

Date ad is needed:

Please attach last year’s ad, if possible:

Is there an opportunity for Needham Bank to participate in the event?

YesNo

*

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?

YesNo