Donation - Partners Bank

Your application will not be considered without the following items:

- Copy of 501(c)(3) classifications from IRS
- Projected budget for program or project, showing sources of funding & expenses

Organization Name*

Address*

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

Phone*

Fax

Website

Email Address*

Please enter N/A if not applicable

Tax ID#*

Contact Person Name*

First Last Title

Address (if different from above)

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

Phone*

Fax

Email*

Please enter N/A if not applicable

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