Charitable Contributions Form

BASF CORPORATION

CHARITABLE CONTRIBUTIONS APPLICATION FORM

To request funds, this form must be completed in its entirety. BASF Corporation will only accept requests from non-profit 501(c)(3) organizations that specifically relate to our primary philanthropic objectives.

Organization Type:

Please indicate the area of focus for your request:*

Eg. Sustainability

Organization's Information:

Requestor's Name*

Requestor's Title*

Name of Organization*

Location (State)*

Full Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Area CodePhone Number

E-mail*

Website Address*

Organization's Mission*

Project / Activity:

What is the purpose for which this contribution is being requested ?*

How many people are impacted by this initiative you are requesting contribution for? *

Is there a specific event associated with this request ?*

YesNo

Location*

Date*

MonthDayYear

Event Name*

How does your organization impact the local community? *

Additional Information:

Amount Requested:

Comments/Other Information:

Please upload your W-9 Form:*

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