Community Giving Request Form
Type of donation:
*
Basket
Monetary
Volunteer time
Date of request:
*
-
Month
-
Day
Year
Date
Name of organization:
*
Name of event (if applicable):
*
Date of event or date donation is needed by (if applicable):
*
-
Month
-
Day
Year
Date
Branch pickup location:
*
Main Bank
Asbury
Grandview
Kennedy Mall
Key West
East Dubuque
Epworth
Farley
Holy Cross
Is the organization a registered nonprofit?
*
yes
no
Organization's main office address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Organization's main phone number:
*
-
Area Code
Phone Number
Organization's web address:
*
Does this organization bank with PVB?
*
Yes, deposit accounts
Yes, loans
Yes, investments
No
Contact name:
*
First Name
Last Name
Contact address:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact name's phone number:
*
-
Area Code
Phone Number
Do you personally bank with PVB?
*
Yes, checking
Yes, savings
Yes, wealth management
No
If PVB volunteers are being requested, please indicate how many, amount of time and for what purpose:
*
Dollar amount requested:
*
Please describe project in detail including objective, benefits, client base and expected results.
*
What percentage of this donation will go directly to the cause?
*
How many people will be impacted by this donation?
*
How will the bank be recognized if the anticipated donation is approved?
*
If approved for assistance, is your organization willing to participate in a check presentation, interview or other activities as requested?
*
If applicable, please mark the box if the PRIMARY PURPOSE of this request willbenefit:
*
Affordable housing primarily benefiting low- or moderate-income individuals.
Community services primarily benefiting low- or moderate-income individuals or geographical areas.
Economic Development (services to businesses that create jobs primarily for low- or moderate-income individuals or tax increment financing (TIF) district loan.
Activities that revitalize or stabilize (Low- or moderate-income geographies, designated disaster area or distressed or under-served non metropolitan middle-income geographies
Neighborhood stabilization program
Additional Information/Comments:
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