Computer Application Form

Notice: We do not give computers directly to individuals. If you’re a student in need of a computer ask a staff member of school to request in your behalf.

Applicant Type*
Organization Name*
Contact Name*
Phone*
Fax
Email*
Enter Email Confirm Email
Address*
Street Address Address Line 2 City Postal Code
Number of Laptops Required(Minimum quantity of 5 with desktops)
Number of Desktops Required(Minimum quantity of 5 with laptops)
Operating System Required*
- Windows 10
- None Required
Do You Need?
- Monitor
- Mouse
- Power Cable
- Keyboard
- Network Cable
- Printer
How are computers going to be distributed and who will be the recipient?*
Comments or Additional Requirements
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