Epique Cares Sponsorship Request

Sponsorship Request Submission

Please tell us about your cause.
Please read the following disclaimer and click "I agree" before sumbitting your request.

Epique Cares is a non-profit organization, and does not fall into a charity of recognized foundation. Epique receives no tax incintives for donations for causes, nor do agents who contribute.

A valid receipt is required for compliance with tax regulations. Failure to provide the required receipt will result in the funds being classified as a commission disbursement to the recipient, which may have tax implications. Furthermore, failure to comply with this requirement will render the recipient ineligible for participation in this program in the future.

Please Note: Approval of benefits requires a unanimous decision from our committee of agent volunteers. This committee—made up of your fellow agents—meets on the last Friday of each month.
To ensure your request can be thoroughly reviewed, please provide as much detailed information and documentation as possible.
Thank you for your understanding and cooperation.

Request Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Name

First NameLast Name
Epique Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
City
State
Your License Number
Amount requested
Requested dollar amount cannot exceed $1,000
Date needed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Reason for request

Is the request for yourself, another Epique agent, or an organization?

Requesting sponsorship for myself
Supporting documents/receipts

Cancelof

Requesting sponsorship on behalf of another Epique Agent
Agent's Name

First NameLast Name
Agent's Epique email address
example@example.com
Agent's State
Supporting documents/receipts

Cancelof

Requesting sponsorship on behalf of an organization
Name of organization
What is the level of impact this sponsorship would have on this organization? Please provide a brief description.
Supporting documents/receipts

Cancelof

To finalize the request for sponsorship, click "Submit" and your submission will be reviewed. You will receive followup communication regarding the status and approval of your request. Some communication may be sent via noreply@jotform.com. Please check your spam folder.

**Please allow up to 30 days for the committee to review your submission**
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