Welcome to River Valley Bank

Donation/Sponsorship Request Form

Please complete all responses and click on the send button at the end of the application. Your request will be sent directly to an RVB Representative.

Name of Organization:
Executive Director
(Mr. Mrs. Ms. Other):
Address:
Telephone:
Director Email:
Web Address:
Primary Contact Name,
if not Executive Director:
Contact Email:
Contact Phone Number:
Purpose of
Event/contribution:		 Operating Capital Program
Project Other
Briefly describe the program or project for which the organization seeks support and who it serves:
Date of event (or when
donation/gift is needed):
Type of Request
Dollar amount:
In-Kind:
Other (ad, logo, etc):
Does this organization serve Low-Moderate income people?
Yes No
Has RVB supported this in the past?
Yes No
When?
What amount?
Is the requesting individual or organization a RVB customer?
Yes No
Please attach supporting materials (flier, mission statement, brochure, ad size, etc.)