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This form must be completed in its entirety to request a charitable donation from CVR Energy, Inc. and its subsidiaries (collectively, "CVR"). CVR only accepts requests from non-profit 501 (c)(3) organizations that specifically relate to our five community impact areas: Youth, Education, Health & Human Services, Environment and Culture.

Please submit this form along with a current W-9 PDF document. Please note that charitable giving requests are processed on a quarterly basis and require no less than 60 days’ notice. For more information, please email CorporateAffairs@CVREnergy.com.

Dates less than 60 days away cannot be entered.
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