ESP International Charitable Foundation

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Natural Disaster

The ESP International Charitable Foundation may help employees who are unable to pay for housing, utilities, food, clothing and other basic living expenses because of a natural disaster, such as a wild fire, flood, tornado, hurricane or earthquake that has damaged or destroyed their primary property. The Foundation is not a replacement for insurance, and cannot pay to repair or rebuild houses or other property or for insurance deductibles. Additionally, the program cannot pay to replace non-essential items, such as electronics or furnishings.

 

Assistance is only granted to help pay for limited types of essential living expenses, such as:

• Medical expenses (not eligible for reimbursement by insurance)
• Housing
• Utilities
• Food
• Clothing
• Other Basic Necessities, at the discretion of the committee

 

Assistance cannot be granted to pay for other expenses, such as:

• Legal fees
• Insurance deductibles and insured property losses
• Credit card bills (other than covered expenses)
• Car payments or repairs
• Funeral expenses

 

Assistance Application/Vendors to be Paid

Date of Natural Disaster*12345678910111213141516171819202122232425262728293031 JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 201920202021202220232024202520262027202820292030

Description of Natural Disaster*

Who has been affected by the Natural Disaster?*

Address (Street, City, State, Zip) *

Phone/Cell Number*

E-mail address*

Submitted by (Name, if different than above)*

What essential living expenses does the affected employee need assistance with?

 Medical

 Housing

 Utilities

 Food

 Clothing

 Other

Please use the following section to document expenses/bills that the employee needs assistance with, such as utilities, housing or medical. There are three Vendor information groups: A, B, C. If needed, we can collect more information after your request is submitted.

(A) Vendor name and address

(A) Essential need provided by this Vendor

(A) Amount owed / needed

(A) Date payment due / need satisfied

(A) Account Number, if applicable

(B) Vendor name and address

(B) Essential need provided by this Vendor

(B) Amount owed / needed

(B) Date payment due / need satisfied

(B) Account Number, if applicable

(C) Vendor name and address

(C) Essential need provided by this Vendor

(C) Amount owed / needed

(C) Date payment due / need satisfied

(C) Account Number, if applicable

Email Address - Submitted By* Send me a copy of form

Please confirm that you are not a script by entering the letters from the image.

Important: Evidence of needs (such as bills, insurance claims etc.) may be requested after submission.

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