Donation Request

Welcome to Republic Bank & Trust! Thank you for including us in your important request. PLEASE NOTE: This donation request form has two sections to complete. After completing this portion of the form and clicking “continue” below, be sure to provide any additional important information on the following page and then click “submit” when finished. FUNCTIONALITY ~Items with an HOURGLASS on the far right-hand side will allow you to see and select multiple answers. ~Items with a DOWNWARD ARROW will have a drop down from which you can choose one selection. COMPLETING THE REQUEST FORM Please be sure to briefly describe your program or project for which your organization requests support. The fields, "HISTORICAL INFORMATION" and "NOTES," are open text fields that you are free to use as needed. The field, "OUR REPRESENTATIVE," allows you to select a Republic Banker, should there be someone with whom you might affiliate this request. Simply begin typing their name and it should auto-fill for you.
Donation Details
Organization Information
Organization Contact