Sponsorship and Charitable Funding Request

Submit a Sponsorship or Charitable Funding Request to EMBARQ by completing the following application.

Organization:

First Name:

Last Name:

Address 1:

Address 2:

City:

State:

Zip Code:

Telephone #:

Fax #:

Email Address:

Were you referred by an EMBARQ employee?

Yes
(Please enter their name):

Are you a qualified 501(c)(3) charitable organization?

Yes (Please enter US tax ID):