Rev. 03/2017
CHARITABLE GIVING PROGRAM
BankFive is committed to supporting its local community through our Charitable Giving Program, in which funds are set
aside to provide support to worthwhile,
non-profit and civic organizations. Completed Requests are carefully evaluated
and considered by a Charitable Giving Committee. A minimum of 2 months prior to the deadline is needed to evaluate
and process incoming requests. The Charitable Giving Committee meets every second Tuesday of the month.
Guidelines for Donation and Grant Requests:
With the growing need in our communities for charitable dollars, BankFive has determined the following will be the
areas in which our contributions will be
targeted to create the largest impact with a limited budget:
• Pr
ograms that support youth education including financial literacy
• Health and social service programs affecting the youth and elderly in our local community assisting low to
moderate income citizens
• Programs that will make a positive impact enhancing business and economic development
Under
no circumstances does BankFive contribute to political parties, candidates, or fundraising events, or any
organization that discriminates on the basis of gender, identity, religion, race, age, ethnicity, marital status, or sexual
orientation.
Procedure for Submitting Request:
Complete the attached Donation Request Form and the required documentation 2 months prior to the deadline is
needed.
• Include copy of 501C(3) Non-Profit Status Form
• Include copy of Taxpayer Identification Number (W-9 Form)
• Include brief cover letter on organizational letterhead, providing all relevant
information not included in the
Donation Request Form, including
Mission Statement
• Include Sponsorship levels and ad specification materials, if applicable
A completed Request Package can be submitted in writing to:
BankFive
Charitable Contributions Committee
Attn: Andrea Amaral Rodrigues
P.O. Box 1191
Fall River, MA 02722
Phone: 774.888.6176
Or fax to: 774-888-6562
A d
igital copy of the package can also be emailed to charitable@bankfive.com.
Date of Request:
Organization: Year Established:
Physical Address:
Mailing Address:
Contact Method (phone, fax, email, or cell):
Is this organization a 501-(c3) nonprofit agency? Yes No
Is this organization a member of United Way?
Yes No
What is the organization's primary mission?
Amount Requested: $
Funds needed by:
Detailed description of how funds will be used.
What percentage of amount requested will be used for programs?
How does this organization or this event help low-to-moderate income groups?
The funds will be used to benefit the following: (check all that apply)
Affordable Housing Community Services for Low to Moderate Income Individuals:
Child Care Health Care
Financial Education
Elderly Services
What area will the funds benefit? (City, State)
Signature of Person making request:
Economic Development
Revitalization of a Low or Moderate Income Geography
BankFive.com | o. 774.888.6100 | toll free 800.679.4420 | 79 North Main Street, Fall River, MA 02720
Required Documentation: Taxpayer Identification Number (W-9 Form); copy of 501C(3) Non-Profit Status Form
Donation Request Form
Submit to:
BankFive
Charitable Contributions Committee
Attn: Andrea Rodrigues, Vice President
79 North Main Street
Fall River, MA 02720
Person Making Request:
Rev. 03/2017
