767 Third Avenue - 17th Floor New York, NY 10017

CHARITABLE DONATION REQUEST FORM

Please fill in all items. Please attach your completed request to a cover letter on an official letterhead

from your organization and submit via email to donations@novatusenergy.com.

Organization Name

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Address

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City/State/Postal Code

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Contact Person

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Phone

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Email

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Website, if any

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Is your organization designated by the IRS as a non‐profit or public tax‐exempt organization as defined

under Section 501 (c)3 of the Internal Service Revenue Code? If so, please provide the Organization’s

Federal Tax ID Number

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Does your organization have any ties to renewable energy?

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2

Has your organization received a donation from Novatus in the past? If yes, what year?

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Describe your organization and its mission

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Provide a brief description of the services provided by your organization and the population served

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Describe the activity or project for which you are requesting a contribution and how the funds will be

used

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If an event, how many people are estimated will attend?

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Who will benefit from this donation? Please be specific

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What donation amount is requested?

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3

When do you need a decision on your donation request?

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Why do you think Novatus should support this activity or project?

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Will Novatus be recognized for its donation?

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Is there any additional information that would be helpful for Novatus to know about your request?

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