Request a charitable contribution. "*" indicates required fields CompanyThis field is for validation purposes and should be left unchanged.Organization*Contact's Full Name* First Last Phone*Email* Organization's Address Street Address Address Line 2 City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Description of event / activity / contribution*Amount Requested*Will these funds used for direct support?* Yes No Where will this contribution be used?*Where will this contribution be used?Hendry CountyGlades CountyPalm Beach CountyMartin CountyHighlands CountyOtherPlease describe how your organization provides direct benefits to residents and/or businesses*Please describe how your organization provides a charitable or a social benefit.*Please describe how your organization will promote or raise awareness of US Sugar. (Include a list of sponsorship benefits and levels.)*Have you or your organization received funding in the past? Yes or No? Please explain or describe.*Please provide a list of other organizations, businesses, or individuals who have committed to sponsoring your cause.*Signature*By digitally signing your name, you understand that U.S. Sugar may request follow-up information on how funds were used to support your organization’s impact.