Donation Request First Southern Bank

Date Request Needed (required)

Street Address

State

Name of Group or Organization (required)

City

Zip Code

Person Making the Request

Title

Email Address

Phone

Fax

Organization's Primary Purpose/Mission

Does your group or organization hold 501(c)(3) nonprofit status?

YesNo

Is your organization or group a customer of First Southern Bank?

YesNo

Are First Southern Bank employees involved with your group or organization?

YesNo

If so, please list employee names

Purpose of your request or name of your event

Location of event:

Shoals area (Lauderdale or Colbert Counties)Other (Another location)

Enter other location here:

Type of Request

Monetary

Amount Requested:

Giveaway Items
Number of items requested:

Reason for request

Fundraising by the Bank on behalf of your organizationBank employee volunteer assistance for your organizationGuest speaker

Will your advertisements/promotions feature First Southern Bank?

YesNo

If yes, please describe:

In what format would you like our logo?

.pdf.jpgother

Enter other format here:

Size?

Email address to send logo

Donation Request