Donation Request Form

* indicates a required field

*Organization Needing Assistance
*Name, Email and Phone of person requesting donation
*Date of event (if applicable)
*What is requested (e.g., cash, door prize, etc. Please be specific.) and how will funds be used?
*Is artwork needed (e.g. logo or advertisement)?	Yes No
If yes, will it be Color or B&W?
If a donation is made, to whom should the check be made out and to what address should it be sent?
*Will a written receipt be provided?	Yes No
*Does the organization bank with THSB?	Yes No
If not, please list the bank that is used
*Do you personally bank with THSB?	Yes No
*Date
Additional Notes:

* indicates a required field