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Do you or any of your board members serve in an elected or appointed public office?
Is the organization a political or religious organization?
Is the organization’s annual revenue $550,000 or less?
What category is your organization?
Does your organization have a banking relationship with Century Bank?
Has Century Bank supported your organization in the past with a sponsorship and/or donation?

The undersigned certifies that they are authorized to represent the organization applying for a contribution and that the information contained in this application is accurate. The undersigned agrees that if a contribution is awarded to the organization:
(1) the contribution will be used for the purpose intended, and
(2) Century Bank has received nothing of material value, aside from noted sponsorship benefits, in exchange for the contribution.

Supporting Documentation
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A Symbol of STRENGTH for More Than a Century