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Park State Bank

Community Donation Request Form

* Required

Request For Gift or Donation

Contact Information

Request For Gift or Donation

Type of Request

Cash Request *
In-Kind Request *

Please Tell Us How the Donation Will Be Used

Check all that apply:
Will the donation be used to provide services to Low-to-Moderate income individuals? Check all that apply:

Please upload any additional information regarding your event including flyers, printed material, and a W-9.

There was an error submitting the form
Thank you for submitting your donation request.  Please allow up to 45 days for the application to be reviewed.