Charitable Donations

CHARITABLE DONATION REQUEST

All of the following information is required in order for us to consider your request for charitable donations.

"*" indicates required fields

Click here for our Charitable Donations Policy

Organization*

Date*

Organization Contact*

First Last

Title*

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Email*

Contact’s relationship to the organization:*

Employee

Volunteer

Paid Worker

Fund Raiser

What services are rendered by your organization?*

What percentage of the donation will be used to help low to moderate income individuals or families?*

How will this donation be used?*

What percentage of your fiscal year budget are your administrative expenses?*

What kind of advertising/signage and recognition will Cornerstone Bank receive, if any?*

Are there any other financial institutions donating at this time? If so, please list.*

What type of contribution are you seeking?*

Monetary

Promotional Item(s)

By what date do you need the contribution?*

Does your organization do business with Cornerstone Bank?*

Yes

To whom should the check be made payable?*

A description of your organization, including its mission and major accomplishments
A copy of the letter from the IRS stating your organization’s 501(c)(3) status, if applicable
A list of key staff, titles and current Board of Directors including office status, if applicable

Cornerstone Bank Charitable Donations Committee P.O. Box 370 Southbridge, MA 01550-370 charitabledonations@cornerstonebank.com

Within 30 days following the event, please provide a letter or program showing how funds were used and the benefits the Bank received.