Application for a Computer - Organization

Application for Computer
Non-Profits, School/Educational, Faith Based Community Services
All 501(C)3 not-for-profit, Public or Private Schools, Faith Based community services and libraries are also eligible for computers as well as servers, networking equipment, overhead projectors, laser jet printers or other hardware we might have on hand.
Please complete the online application form.  Non-profits please upload a scanned copy of your IRS determination letter.
Date *  Telephone 
Organization Type *  Please attach IRS determination letter or other documentation
Organization Name * 
First Name *  Last Name * 
Street  State 
City  Zip 
Title/Position  Fax 
Email *   
Mailing Address
if different
than above 
General Description
of Community
Services Provided 
Demographic Info  Clients served yearly 
Description of Equipment
 or Services Requested  
Lead Source
What will the
equipment be
used for? 
Upload IRS or other determination info Max File size limit is 20MB
I herby certify that the above is true and correct
Sign Here *