Donation/Sponsorship Request Form Δ Date(Required) Name of Charity Organization(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Phone(Required)Example Format: 10 digits (5551234567)FaxContact Person(Required) First Last Email(Required)Example Format: [email protected] Date of Event/Donation Deadline(Required) Is someone that works at BankChampaign affiliated with your organization?(Required) Yes No Name of person at BankChampaign affiliated with your organization(Required) First Last Role of person at BankChampaign affiliated with your organization(Required)What is the reason for this request?(Required)How will the donation/sponsorship money be used?(Required)Will the donation/sponsorship funds be kept locally?(Required) Yes No Does your organization bank with us?(Required) Yes No What type of accounts do they maintain?(Required) Checking Savings Personal Loans Credit Cards Debit Cards Do you personally bank with us?(Required) Yes No Did your organization’s bank donate?(Required) Yes No What level or amount did they donate?(Required)Did you donate for this specific cause?(Required) Yes No Will you need our logo for sponsorship advertising?(Required) Yes No Detail the marketing/advertising/PR value the bank receives from this donation/sponsorshipHave we donated to your organization in the past?(Required) Yes No Past donation date from BankChampaign(Required) Past donation level or amount from BankChampaign(Required)CAPTCHA
