Community Support Request Form

Community Support Request Form

* Required fields
Contact Name *

First Name Last Name
Organization Name *
Contact E-Mail *
example@example.com
Contact Phone Number *
Submission Deadline *

Month Day Year
Date
Requested Donation Amount *
Organization's Social Media URL
Sample: https://www.facebook.com/RhinebeckBank
Mailing Address *

Street Address

Street Address Line 2

City State

Postal / Zip Code
Is your organization a 501c(3)? *

Yes No
Do you, or your organization, bank with us? *

Yes No
Did you speak with someone from a Rhinebeck Bank branch about your request prior to completing this form?

Yes No
If Yes, please enter the employee's name here:
Please describe the nature of the request and/or event below, including details regarding how the funds will be used. *
Be sure to include any information regarding ad or logo needs (i.e.: size, file type, etc.)
If you have supporting materials related to your donation/sponsorship request, please upload them here (file size limit = 10MB):

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Please allow 30-45 days for processing of your request.

Requests with earlier deadlines may not be able to be considered.
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Community Support Request Form

Please allow 30-45 days for processing of your request.