Donation Request

Organization Information

Organization Name*

Street Address*

City*

State*

Zip*

Phone Number*

Your Name*

Website*

Your Phone Number*

Your Email Address*

Organization Type*

Please list your 501(c)(3) number

Please list your Registered VT Business Name*

Amount Requested*

Annual Budget of your Organization*

% of Total Expenses Used for Program Activities*

% of Donation Used to Directly Benefit Organization*

Please be sure your VT Business Entity registration is current. Any status other than 'Active' cannot be granted funds. Visit VT Secretary of State Business Services Divisions online to verify.

Does your organization have paid or volunteer staff*

paid Paid

volunteer Volunteer

Can you provide financial information including income and expenses of your event and/or organization?*

Event Information

Please list the name and description of the event:*

What areas (towns, cities, counties) does your event serve?*

Please describe the benefits to the community by sponsoring your request:*

Please describe the benefits to Peoples Trust Company by sponsoring your request:*

List all other sponsors/donators/supporters:*

Please list any other information you believe is pertinent in determining the approval of your request:*

How will the funds benefit the recipient?*

Did Peoples Trust Company sponsor this event last year?*

Date of Event:*

What is the deadline to receive funds?*

By checking this box I am personally verifying all information above is correct and accurate. By checking this box I am personally verifying all information above is correct and accurate.

Thank you for your interest in Peoples Trust Company.

We will contact you shortly with the information you requested.