Corporate Sponsorship Request Form

Charitable Guidelines: Arkansas Blue Cross Blue Shield is a proud supporter of our local community. For donation consideration, please fill out this form in its entirety as well as provide the necessary documentation requested. We require a 501(c)(3) tax id number and may ask for a copy of your IRS non-profit determination letter for any and all donation requests. Any organization without a valid 501(c)(3) tax id number and/or those who cannot present the required documentation will not be eligible for a donation. Completion of this form does not guarantee a donation. Arkansas Blue Cross Blue Shield Donations are solely awarded at the Corporate Contributions Committee's discretion.

When you encounter a question in the survey that you are unable to answer, please indicate "Not available" in the required fields.

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* 1. First Name

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* 2. Last Name

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* 3. Title

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* 4. Email Address

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* 5. Work Phone Number

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* 6. Organization's Name

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* 7. Organization's Mailing Address

Address 1 (Street Name and Number)

Address 2 (Suite Number)

City

State Abbreviation

Zip Code

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* 8. Organization's Mission Statement

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* 9. Organization's Website

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* 10. Please inform us how you learned about the Arkansas Blue Cross and Blue Shield sponsorship opportunity. If an ABCBS employee referred you, please provide their name.

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* 11. When is the deadline for responding to this request?

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* 12. Tax ID Number

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* 13. Please upload your organization's annual report.

PDF, DOC, DOCX, JPG, JPEG file types only.

Choose File

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* 14. Social media links

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* 15. What initiatives and programs will benefit from this request ?

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* 16. Will this request have Statewide Impact ?

Yes