Contribution Request Form

Aquarion Water Company actively supports non-profit 501(c)(3) organizations in its service areas that promote environmental conservation and awareness, education, health, and cultural appreciation.

Our contribution committee review process will take 30 to 60 days ― we appreciate your patience.

Grant requested by:  
    *First Name / Last Name
    *Zip Code
    *Phone Number
 -   -   Ext.   
    *Email Address:
    *Email Verification:
(We will never disclose your email address
 to third parties
Amount requested:
In the event we grant your
request, what portion of the
donation is tax deductible?
Purpose of the program, event, activity, or organization for which the grant
is requested:
Please attach a completed W-9 form and any relevant materials that you
would like our committee to review with your request.
Attach file(s):
Note: * Indicates required fields