Charitable Support and Grant Requests | Placid Refining Company, LLC

Name*

First Last

Email*

Best Phone Number*

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Are you a full-time Placid employee or third-party contractor?*

Company Name*

Did someone refer you to Placid?*

Who referred you?*

Amount of Request:*

When do you need it?*

Is this request for an organization?*

Is it a non-profit?*

Is it properly registered with the IRS?*

Is it based in Louisiana*

What parish?*

What state?*

What is the mission?*

What proportion of funds will benefit mission?*

Is this a reimbursement or advance check?*

Is the request part of an event?*

What is the event?*

Would you like someone for Placid to attend?*

Will pictures of the event be allowed?*

Additional Comments

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