Giving Mission Application › Home State Bank

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Home State Bank Contributions & Sponsorship Request Form

"It's a Community Thing"

Home State Bank gives through both our financial contributions and volunteerism to community organizations within McHenry County. We are proud of our associates who contribute countless hours to support local not-for-profit causes.

* Indicates required field. If a question/field does not pertain to your request, please enter "N/A".
Thank you.

Name of Organization *

Name of Person Requesting the Sponsorship *

Organization Email Address *

Organization Street Address *

City *

Zip Code *

Phone Number *

Brief explanation of organization's objective *

Name of Event *

Date of Event *

Location of Event *

Street Address to Mail Check *

City *

Zip Code *

Deadline Date *

Ad included w/sponsorship * Yes No

Size of ad needed *

Date needed *

Email Address to send ad *

Tax ID Number *

Is the organization 501c3? * Yes No

Are there any Home State Bank associates involved with the organization or Board? * Yes No

Name of associate involved with your organization or Board *

Does the organization or member have any current banking relationships with us? * Yes No

If yes, name the member who has a current relationship with HSB

Did you email your W-9? * Yes No

Did you mail your W-9? * Yes No

In order to be considered for a contribution or sponsorship, please submit a required* copy of the organization's W-9 along with a copy of your event flyer or information sheet to:

Brett Berg at bberg@homestateonline.com

Home State Bank
Attn: Brett Berg
P.O. Box 1738
Crystal Lake, IL 60039-1738

*Under the Federal Income Tax Laws, Home State Bank and its subsidiaries are required to have on file a Tax Identification Number for any business or individual to whom we made certain payments. This requirement can be met by attaching a W-9 Form. If you are exempt from backup withholding, you will need to provide proof of such exemption. If you have any questions pertaining to your W-9 you may call Mike Sena at 815-788-7811.

Due to the volume of requests, no application will be reviewed until it is submitted in its entirety.

Thank you for your application!

Someone will be in touch with you soon.

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Home State Bank Contributions & Sponsorship Request Form

"It's a Community Thing"

In order to be considered for a contribution or sponsorship, please submit a required* copy of the organization's W-9 along with a copy of your event flyer or information sheet to:

Thank you for your application!