Charitable Contribution Form

Charitable Contribution and Sponsorship Form

Choose a category or subcategory

B. Braun and its U.S. affiliates support requests from non-profit organizations serving local communities where our manufacturing facilities and offices are located. Priority consideration will be given to requests for funding programs that support:

The under-served, minority or health disparate populations
Advancement of STEM education and manufacturing skills
Community-based arts and cultural programs
Opportunities for children and diverse populations

All requests for charitable contribution and sponsorship need to be received at least three (3) months before the donation is required. Please complete this form and submit it for processing; requests with missing information or supporting documentation will not be considered.

Requesting Organization Name

Requesting Organization Address Line 1

Requesting Organization Address Line 2

Requesting Organization City

Requesting Organization State

Requesting Organization Zip

Requesting Organization Country

Requesting Organization Tax ID Number

Requesting Organization Tax Status

Requesting Organization Type

Requesting Organization Contact Name

Requesting Organization Contact Job Title

Requesting Organization Contact Email

Requesting Organization Contact Phone

Charitable Program Name (if applicable)

Type of charitable cause

Number of people benefiting from the charitable event/program

Event Date (if applicable)

In which state is the community that will benefit

City of the community that will benefit

Event Description

Requested Amount

Describe how the funds will be used

Will B.Braun employees have the opportunity to participate in the charitable event or program? If so, please explain

Will you require any documentation from B.Braun (for example, a certificate of insurance, donation agreement, etc.)

Non-Profit Designation Letter

IRS Form W9

Statement of Charitable Mission

Information, brochure or pamphlet describing the fundraising activity and levels of sponsorship

Diversity Statement (or include with Statement of Charitable Mission)

Any necessary documentation B. Braun will be asked to sign

Requests and Documentation may also be

Emailed to:
GrantRequests@bbraunusa.com

Mailed to:
c/o B. Braun Medical Inc.
Attention: Corporate Compliance
824 Twelfth Avenue
Bethlehem PA, 18018

Compliance is what gives us the right to do business. At B. Braun, each of our employees is responsible for doing the right thing for the Company and for themselves. Acting in compliance allows us to continue to make a true difference for our customers and the patients they serve.

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Requests and Documentation may also be

Compliance is what gives us the right to do business. At B. Braun, each of our employees is responsible for doing the right thing for the Company and for themselves. Acting in compliance allows us to continue to make a true difference for our customers and the patients they serve.