Donation Request Form
Lone Star National Bank
Date of Request:
Have you received a Lone Star National Bank donation in the past?
Yes *
No
Amount donated in the last 5 years:
* please specify
years and amounts
Organization Name:
Profit
Non-Profit
First Name:
Last Name:
Title:
Address:
(we cannot ship to a PO Box)
City:
State:
Phone:
Fax:
Tax ID:
Email:
Website:
Tax-exempt #:
Event Name:
Event Date:
Event Time:
City:
State:
Zip:
About the Event/Organization
What is the focus of your event/organization?
Projected Attendance*
Who is your target audience?
Zip:
Please provide detailed information about the event/organization:
Will representatives of Lone Star National Bank be needed at this event
and at what capacity?
*Lone Star National Bank reserves the right to determine
the number of promotional items you will receive.
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Donation Request Form
Lone Star National Bank
About the Event/Organization (continued)
What would you like Lone Star National Bank
to provide?
How will you use our contribution to support
your event/organization?
How will Lone Star National Bank be mentioned during
the event; program, signage, advertising, etc.?
Average value of
assistance:
Who are the beneficiaries of
your organizations’ services?
Please be as specific as possible regarding level of
sponsorship, amount of promotional items, monetary
contribution.
What is the reach/impact of the organization i.e.
(scholarships, sponsorships, assistance) for the
last 5 years?
I/we agree to provide detailed information, upon request, on the income level of the
beneficiaries of the services to low-moderate income families and individuals.
Additional Comments:
Provide the following documents along with your request form:
• Annual audit
• List of spending (Use of funds)
• List of board members
• List of recipients of benefits
Lone Star National Bank
Attn: Marketing Department
520 E. Nolana Ave., McAllen, TX 78504
Fax: (956) 984-2953 • Email: [email protected]
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All fields must be completed in order for your application to be considered. Thank you.
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