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
*
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):
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Please allow 30-45 days for processing of your request.
Requests with earlier deadlines may not be able to be considered.
Please verify that you are human
*
Submit
Should be Empty: