image of bank at Buffalo Center
Name of Organization:
Contact Person Name*
Phone
Email*
Project funds are needed for:
Amount Requested:
Total Project Cost:
Is this a one-time donation One-time donationAnnualOther frequency
Where does your entity keep funds on deposit?
What other organizations have or will be contributing and what amount?
Make check payable to:
Name: Address: City/State/Zip:
Phone Number: Email Address:
Supporting documentation can be emailed to aliceap@ftsbbank.com