Donation Request

Organization Information

Completion of this form DOES NOT guarantee The Bank of New Glarus will fulfill the request.

* - Indicates required fields

Organization Name*

Type of Organization*

Mailing Address

Address Line 1*

Address Line 2

City*

State*

ZIP*

Phone*

Website or Social Media Page

Mission Statement / Event Description*

Contact Information

First Name*

Last Name*

Email*

Phone*

Donation or Sponsorship Details

Select an office located nearest your organization*

Type of Request*

Date Needed By*

Upload Supporting