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Donation Request Form

Donation Request Form
JD Bank asks that all organizations requesting financial support from us complete this questionnaire. We ask that your request be submitted at least two months in advance for proper consideration. Those not providing ample time for consideration may limit their opportunity for support. Completion of this form DOES NOT guarantee that JD Bank will be able to fulfill the request.Incomplete forms and those without documentation will automatically be denied.
Date of Request*
Date Format: MM slash DD slash YYYY
Organization Requesting Donation*
Person Making Request*
First Middle Last
Physical Address
Physical Address (Not a P.O. Box)*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mailing Address
Mailing Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Contact Information
Email*
Contact Phone Number*
Contact Cell Phone (Optional)
Contact Fax (Optional
DOCUMENTATION NEEDED: YOU WILL NEED TO ATTACH A DIGITAL COPY OF YOUR IRS DESIGNATION LETTER, ALONG WITH A DIGITAL COPY OF IRS FORM 990 AT THE END OF THIS APPLICATION. FAILURE TO DO SO WILL RESULT IN AUTOMATIC DENIAL.
1. Is this organization a 501(c)(3) nonprofit agency?*
- Yes
- No
2. Is this donation tax deductible?*
- Yes
- No
3. Is this organization a member of United Way?*
- Yes
- No
4. What is the organization’s primary mission?*
5. Amount requested?*
Funds needed by:*
Date Format: MM slash DD slash YYYY
6. Detailed description of how funds will be used.*
7. What percentage of amount requested will be used for programs?*
8. How does this organization or this event help low-to-moderate income groups?*
9. Where will the activity take place?*
10. Will there be any advertisement or promotions featuring JDB?*
- Yes
- No
If Yes, Please Describe:*
11. Have you contacted other JDB offices / employees?*
12. Is the requesting organization a customer of JDB?*
- Yes
- No
If “yes”, what relationship(s) do you have with us?*
13. Are any employees of JD Bank involved in the effort? Please list.
14. Has JDB participated in the past? In what way?
Please Upload IRS Designation Letter
Please Upload IRS Form W-9
Security Code
THIS FORM WILL NOT SUBMIT WITHOUT ATTACHING THE IRS FORM 990 & DESIGNATION LETTER.
By hitting submit you are digitally signing this document, and attest that the information provided here within is true.
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