Donation Request

Please fill out this secure online form and click on the submit button to automatically send your donation request. You can also complete, print, and (if necessary) scan the form to send it by email (, fax (304-257-4386), or regular mail (Grant County Bank, attn: Christy Buckles, P.O. Box 929, Petersburg, WV. 26847).

* Required Fields


Organization Name* Contact Name*
E-mail* Phone Number*
Address City
State Zip Code
Event Name Event Date
* Our organization is requesting
 Monetary Donation
 Door Prize(s)
 Promotional/Giveaway Materials

How will the donation be used and what amount is being requested?


Event Description


* Please note that completing and submitting a donation request form does not ensure that the request will be granted.


NOTE:  Only click the Submit button once. Because it is encrypted, this transmission may take up to one (1) minute to complete.