Community

Community Giving Form

• Organization Information

• Name of Organization *
• Executive Director/Manager *
• NonProfit

  NonProfit * Yes No
• Address *
• City *
• State * --- Select --- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware DC Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• Zip *
• If mailing address or the name of the entity to whom a check would be cut is different than above, enter it here:
• Does the organization or executive director have an account or loan through Prevail Bank? *

  Yes No No, but would consider Don't know

• Contact Information

  
  
• Contact Person *
• Contact Person's Phone *
• Contact Person's Email *

• Project Information

  
  
• Total Dollar Amount of Project *
• Total Dollar Amount Requested *
• Purpose of Organization *
• 
  
  Purpose & Details of Requested Donation *
• Other Facts, Stats, Community Benefits & Outcomes to Consider
• Check all that apply *

    Project/donation assists only low-to-moderate income people   Project/donation will assist the community financially and/or economically   Project/donation will enhance the standard of living of those assisted   Project/donation provides financial management education to those assisted   Project/donation benefits more than 100 people   Other
• If donors are recognized/acknowledged in some way, please explain.

• If you need any assistance or need to send additional documents, please contact the Marketing Department directly.