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HVAC & Plumbing

Service Request Form

If this is an emergency please Contact Us Here

Company Name(Required)

Phone(Required)

Company Contact(Required)

Company Email(Required)

PO Number(Required)

Billing Address(Required)

Job Site Information

Job Location(Required)

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Contact On Site

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Community Contribution

Guidelines for Massey Group non-profit contributions:

All applicants must provide a current application, a copy of your current Board of Directors, and verification of 501 (c) 3 status.

Agency Name(Required)

Contact(Required)

Contact's Email(Required)

Address(Required)

Company Phone(Required)

Contact's Phone(Required)

Amount of Massey Group Contribution Requested for FY:(Required)

Prior contributions received from Massey Group

2016

2017

2019

2020

Are you a non-profit charitable organization?(Required)

Yes

Are you a non-profit civic organization?(Required)

Yes

How many years have you received non-profit contributions from Massey Group?(Required)

In fifteen words or less please categorize the type of service you provide.(Required)

How many clients did you serve in the prior year?(Required)

Who will be the recipients of the Massey Group contribution?(Required)

Are the funds earmarked for a specific group?(Required)

Yes

What is the specific purpose or program for which Massey Group contribution will be used?(Required)

What is the purpose or overall mission of your agency or organization?(Required)

What is the local (and national if affiliated with a national organization) administrative overhead for your organization?(Required)

Does your agency receive any other funding? If so, please list source and how much is received by each source.(Required)

All applicants must provide a current application, a copy of your current Board of Directors, and verification of 501 (c) 3 status. Please send all attachments to info@masseyelectric.com

All incomplete and late applications will not be processed.

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Contact Us

Service Request Form

If this is an emergency please Contact Us Here

Job Site Information

Community Contribution

Request a Bid

Job Site Information