Organization Information
Organization Name
*
Entity Type
Please Select
For Profit
Non Profit
Municipality or Government
Tax ID
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Website
*
Is your organization a customer of Western Security Bank?
*
Yes
No
What is your organization's mission statement?
*
What services does your organization offer?
*
Where is your organization's service area?
*
Eligible organizations must serve Yellowstone, Carbon, or Stillwater County
How many individuals does your organization serve anually?
*
Unduplicated
What percentage of those served are low-to-moderate income individuals?
*
How does your organization determine low-to-moderate income status?
*
Contact Name
*
Title
*
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Donation Information
How would the financial gift be used?
*
Who would this gift benefit?
*
How many people would benefit from this gift?
*
What percentage of beneficiaries would be low-to-moderate income individuals?
*
Eligible requests must be greater than 50%
What service project could Western Security Bank complete for your organization?
*
Other Information
Does your organization have a need for the following:
*
Board members
Financial education workshops
None
Explain these needs further and how we might be able to help.
Please attach any additional support documentation.
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