Presentation Request

1. Please tell us about you and your group or organization:

To be considered for a presentation by Benchmark Community Bank, please provide the following information:

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1. Your name:

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2. Name of the facility, organization, or group making this request:

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3. Which community or communities do you serve or represent?

Kenbridge

Victoria

Farmville

Crewe

Blackstone

Lawrenceville

South Hill

Chase City

Clarksville

South Boston

Halifax

Other (please specify)

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4. How can we reach you?

Mailing address:

Phone number:

Email address:

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5. Do you, your organization, or your group currently bank with us?

Yes

No

Note:

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6. If no, would you like information on our Community First (for non-profits), business, or personal checking accounts?

Yes

No

Please specify which:

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7. Please tell us about any Benchmark associates who are part of your organization.