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Corporate Giving Program
Application Questionnaire
Application Questionnaire
Leave this field blank.
Please indicate what you are requesting
Printer
Surplus office supplies or furniture
Please classify your organization
Animal Welfare
Arts and cultural organization
Athletic Team
Church or religious organization
Civic or community organizations
Education
Environmental or natural preservation
Fraternal organization
Labor organization
Political organization
Social or child welfare
Government agency or military
Health and human services
What type of support will this donation provide?
Sporting or recreational program
General operating support
Silent auction, raffle or door prize
Organization event or support
Is your organization based out of a private home or an office?
Private home
Office
Lexmark's corporate giving program does not support organizations that practice discrimination. Is your organization selective by race, color, creed, sex, age, sexual orientation or national origin?
Yes
No
In order to give each charitable request full consideration, Lexmark encourages four to six weeks advance notification. Please indicate when your request requires attention.
Within one week
Two to four weeks
More than four weeks
Please provide a description of the event or use of the donation
Organizational Background
Please indicate the date you need this request fulfilled:
Focus of the organization
Arts and Culture-Environmental organizations
Arts and Culture-Historical and cultural preservation societies
Arts and Culture-Libraries
Arts and Culture-Museums
Arts and Culture-Performing and Visual Arts
Arts and Culture-Public Broadcasting-Public Radio
Arts and Culture-Public Broadcasting-Public Television
Arts and Culture-Zoos/Botanical societies
Civic & Community-Government and Military
Civic & Community-Community Issues & Development-Community Organizing
Civic & Community-Community Issues & Development-Economic Development
Civic & Community-Community Issues & Development-Public Policy
Civic & Community-Technical Assistance Centers
Education-College/University-Private
Education-College/University-Public
Education-K-12-Private Education-K-12-Public
Education-Preschool-Private
Education-Preschool-Public
Education-Vocational/Technical School
Equal Opportunity/Affirmative Action-Physical Disability
Equal Opportunity/Affirmative Action-Native American
Equal Opportunity/Affirmative Action-Asian
Equal Opportunity/Affirmative Action-Hispanic/Latino
Equal Opportunity/Affirmative Action-Women
Equal Opportunity/Affirmative Action-Veterans
Equal Opportunity/Affirmative Action-African-American
Health, Human, and Social Services-Animal Welfare
Health, Human, and Social Services-Child welfare
Health, Human, and Social Services-Homeless/Shelters
Health, Human, and Social Services-Hospice
Health, Human, and Social Services-Hospitals
Health, Human, and Social Services-Literacy
Health, Human, and Social Services-Medical Research
Health, Human, and Social Services-Nursing Home
Health, Human, and Social Services-Senior Citizens
Organization Information
Organization name
Street Address
City
State/Province
Zip Code
Country
United States
Canada
Country
--
United States
Canada
Phone Number
Web Address (if applicable)
Tax Status
501c(3)
501c(6)
509a(1)
Other
Contact Information
Prefix
Mr.
Mrs.
Ms.
First Name
Last Name
Title/Position
Email Address
Contact Phone Number
If you are a Lexmark employee or a Lexmark employee referred you to this site, please state employee name
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