Charitable Giving Request Form

This form must be completed in its entirety to request a charitable donation from Allegiance Refining. All requests require at least 30 days advance notice.

Please submit this form along with a current W-9 PDF document. You are welcome to include supporting documentation, if needed.

Requestor First Name

Requestor Last Name

Requestor Email

Requestor Phone Number

Company Name

Company Address

Website Address

Your Organization's Mission

Details of Request

Date Donation is Needed

Amount Requested

Do you have a contact at Allegiance Refining? If so, please inlcude their name and title.

What additional items do you need? (Logos, branded items, ads, etc.)

Completed W-9 Form

Upload File (PDF Only)

Only PDF Documents Accepted

Supporting Documentation (Optional)

Upload File (PDF Only)

Only PDF Documents Accepted

Your request has been submitted. Please allow 30 days for a response.