Donation, Sponsorship, Advertising

Your Contact Information

First name*

Last name*

Phone

Email*

Organization Information

Organization Name*

Address*

Street Address Address Line 2 City State ZIP Code

Federal Tax ID Number (If applicable):

Is the organization a Bert Adams Disposals customer?*

Yes
No

If yes, what is the organization's Bert Adams Disposals customer number?

Event information

If your donation or sponsorship request is not related to an event, please mark NA for the following fields.

Event Name

Event Venue

Event Address*

Street Address Address Line 2 City State ZIP Code

Date*

Expected Attendance

Is Bert Adams Disposal currently scheduled to provide service for the event?

Yes
No

Description Of Your Request

Describe your request (i.e. number of containers needed, monetary donation amount). Please be as specific as possible. NOTE: Bert Adams Disposal rarely offers services at no charge; however, advertising and sponsorship involvement may result in service discounts, if contribution budget allows.

Description

Date support is needed (date response is needed)

NOTE: We do our best to respond to each request within 30 days. If your request is needed sooner than 30 days, we may not be able to assist or respond. However, we do encourage you to note this special consideration in the field below so we may attempt to expedite your requests.

Date Needed*

Have you applied for support from Bert Adams Disposal in the past?

Yes
No

Please describe the past assistance from Bert Adams

Sponsorship Recognition & Advertising Opportunities

If Bert Adams Disposal is able to support your request, please detail how your organization will recognize Bert Adams Disposal.

Please check all that apply.

Company name in promotional materials
Logo in promotional/print materials
Advertisement in promotional/print materials
Company listing on website
Advertisement on website
Other

Bert Adams Disposal appreciates the efforts your organization is making to ensure a positive difference in our communities. Your request is important to us. Please know that all donation requests are considered by a Contributions Team. If Bert Adams Disposal is able to offer assistance, we will contact you directly. Otherwise, we request that you remain patient as we do our best to lend equal consideration to all requests.

Name

This field is for validation purposes and should be left unchanged.

Sponsorship

Donation, Sponsorship, or Advertising