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Organization Name
Is this a registered charity or a 501(c)(3)* Yes, this is a registered charity or a 501(c)No, this is not a registered charity or a 501(c)
Contact Person
Email*
Phone*
Address*
City*
State* —Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
Date & Time of Event*
Location of Event*
Purpose of Event*
Goods/services requested and the dollar value*
Who does this Organization benefit*
Are you or someone associated with this organization a customer of FVSBank?* Yes, myself or someone associated with this organization is a customer of FVSBankNo, neither myself nor someone associated with this organization is a customer of FVSBank
Name*
Promotional Opportunities: (Please provide evidence/details of how our organization will be acknowledged.)*
Other Supporting Information: Briefly describe why we should consider your request, event management capabilities or any other information that may influence our decision to provide support.*
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