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Donation_Request

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					                                                                 REQUEST FOR DONATION
                                                                     OR CONTRIBUTION
        First National Bank
        and Trust Company of Ardmore                                 Date: __________________________
        Ardmore  Lone Grove  Marietta
        Ringling  Sulphur  Velma


      (All information requested on this form must be completed in order for this request to be considered
       by the Bank’s Donation/Contribution Committee)

             Amount Requested: ___________________________
  PURPOSE / USE OF FUNDS: _______________________________________________________________
                                          _______________________________________________________________
                                          _______________________________________________________________
                                          _______________________________________________________________
                   RECIPIENT
     Funds should be payable to: ___________________________________________
                          Address: ___________________________________________
                                          ___________________________________________
                         Tax ID #: ___________________________
Recipient’s Account Relationship
        with First National Bank: _______________________________________________________________
    Is Recipient registered with the IRS as a 501(c)3 (Non-profit) organization? ____ YES or ____ NO
                       Has Recipient received donations/contributions from the
                              First National Bank within the past five (5) years? ____ YES or ____ NO
   If YES, how much and when? _______________________________________________________________
                 REQUESTOR
     Individual Making Request: ___________________________________________
                          Address: ___________________________________________
                                          ___________________________________________
        Daytime Phone Number: ___________________________
Requestor’s Account Relationship
        with First National Bank: _______________________________________________________________
    Special Requests/Instructions _______________________________________________________________
                        (Optional) _______________________________________________________________
                 Please deliver
                this request to: Ryan Youderian, Vice President
                                 Chairman, Donations/Contributions Committee
                                 PO Box 69
                                 Ardmore, OK 73402-0069
    Approved _________                                                                        Denied _________

				
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posted:8/12/2011
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