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Donation Request Form

Donation Type(*)

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Organization Name(*)
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Name of the Person Completing the Form(*)
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First & Last Name

Donation Amount $(*)
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Address (*)
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Full Address

Phone Number(*)
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Ex: 555-555-5555

Website Address
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Fax Number
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Ex: 555-555-5555

Email Address
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Have you received support from CNB in the past?(*)

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Are you a 501 (c) 3 organization?(*)

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Are you a local chapter of a national charitable organization?(*)

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Are you a CNB customer?(*)

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Mission statement or purpose of your organization(*)
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About your Activities(*)

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Geographic region(s) your organization serves(*)

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Please list any CNB employees or directors that volunteer for your organization
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Description of the project or program for which you are requesting funds(*)
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Projected project cost(*)
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$

Number of people served(*)
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Age group served(*)
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Youth, seniors, etc.

Organization’s annual budget(*)
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$

Total percentage of expenses used for program activities(*)
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%

List other organizations you are collaborating with on this program or project
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How will success of this program or project be measured?(*)
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How will CNB be recognized for this donation?(*)
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Event Date(*)
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Date you need to receive the funds(*)
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Date that artwork, logo or banner are needed (if applicable)
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Project completion date(*)
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Address where the funds need to be mailed(*)
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Full Address

 

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Donation Request Form

Donation Type: .

Organization Name: .

Name of the Person Completing the Form: .

Donation Amount $: .

Address (Street/City/State/Zip): .

Phone Number: .

Website Address: .

Fax Number: .

Email Address: .

Have you received support from CNB in the past?: .

Are you a 501 (c) 3 Organization?: .

Are you a local chapter of a national charitable organization?: .

Are you a CNB customer?: .

Mission statement or purpose of your organization: .

About your Activities: .

Geographic region(s) your organization serves: .

Please list any CNB employees or directors that volunteer for your organization: .

Description of the project or program for which you are requesting funds: .

Projected project cost: .

Number of people served: .

Age group served: .

Organization’s annual budget: .

Total percentage of expenses used for program activities: .

List other organizations you are collaborating with on this program or project: .

How will success of this program or project be measured?: .

How will CNB be recognized for this donation?: .

Event Date: .

Date you need to receive the funds: .

Date that artwork, logo or banner are needed (if applicable): .

Project completion date: .

Address where the funds need to be mailed: .