Donation Requests

Please fill out the information below:

Contact Information
Name of Organization:
Contact First Name:
Contact Last Name:
Contact Phone Number:
Contact E-mail Address:
Mailing Address:
City:
State:
County:
ZIP:
Request Information
Federal Tax ID Number (If applicable):
Specifics of support requested (i.e. number of containers needed, monetary donation amount):
Dates support is needed:
Event location:
Please describe the purpose of the request:
How many people does your event or organization reach?
Have you applied for support from Rumpke in the past?
Has Rumpke honored your request in the past?
If yes, what were the specifics of the request honored (dollar amount or service):
List promotions, advertising or recognition Rumpke may receive by providing support: