Donation Request Form

Please fill out the fields in the form below. One of our representatives will contact you within one business day to complete the process. Completion of the account opening must be done within 10 days at a local branch as a copy of your ID and a signature is required. If no action is taken within 10 days, the account will be closed. 

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Donation / Ad Request

  • OK Name of Organization is required
  • OK Amount of requested donation or ad is required
  • OK Purpose of the donation or ad is required
  • OK Do you or your affiliation have any accounts with Belgrade State Bank? is required
  • OK Requesting Party is required
  • Optional OK Phone is required

  • Date Needed by

    OK Date Needed by is required
  • OK Make Check payable to is required

  • Mail Check?

    OK Mail Check? is required
  • OK Check to be picked up by is required
  • OK Mailing Address (Not a P.O. Box) is required
  • OK City is required
  • OK State is required
  • OK Zip is required

Security Code

  • OK is required