Raccoon Valley Bank Donation Request Form

* = Required Field

• Date Request Needed
• Name of Organization
• Location of Event (if applicable)
• Address
• Person Making the Request
• Title
• Email
• Phone
• Amount Requested
• Are you a 501C organization? -- Select -- Yes No
• Organization's Primary Purpose/Mission
• Description of how funds will be used
• Will there be any advertisement or promotions featuring RVB? If yes, please explain.
• Does the organization have a relationship with RVB? Please explain.
• Previously, has RVB donated to this organization?
• Special Instructions