Donations and Sponsorships Request Form
Group or Organization Information
Date Request Needed:
Name of Group or Organization:
Person Making the Request:
Organization’s Primary Purpose/Mission:
Does your group or organization hold 501(c)(3) nonprofit status?
Is your group or organization a customer of Bank Independent?
Are any Bank Independent employees involved with your group or organization?
If so, please list employee names:
Details of Request
Purpose of your request or name of your event:
Location of event:
Shoals area (Lauderdale or Colbert Counties)
Athens area (Limestone County and Rogersville, Ala.)
Decatur area (Morgan County)
Moulton area (Lawrence County)
Russellville/Red Bay area (Franklin County)
Type of request
(check all that apply):
| Amount requested: $
| Number of items requested:
Fundraising by the Bank on behalf of your organization
Bank employee volunteer assistance for your organization
Will advertisement/promotions feature Bank Independent?
If yes, please describe:
In what format would you like our logo?
Email address to send logo:
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