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Donations and Sponsorships Request Form

  • Group or Organization Information   
    Date Request Needed:
     [None] Select a Date Delete the Date
    Name of Group or Organization:
    Street Address:

    Person Making the Request:
    Email Address:

    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:

    Type of request (check all that apply):
       |   Amount requested: $ 
       |   Number of items requested: 

    Advertising Information 
    Will advertisement/promotions feature Bank Independent?   
    If yes, please describe:
    In what format would you like our logo?            Size?
    Email address to send logo:

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