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
    
    *Organization
 
Address:
 
    *Street 
    *City
    *State
    *Zip Code
 -   
    *Phone Number
 -   -   Ext.   
    *Email Address:
    *Email Verification:
(We will never disclose your email address
 to third parties
)
 
Amount requested:
.00
 
In the event we grant your
request, what portion of the
donation is tax deductible?
.00
   
  
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