Westchester PC Renew Application for Computer (non-profit organizations only)
Organization
Organization Name:
*
Enter the full name of your organizaton.
Organization Address:
*
City:
*
State
Please select...
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Zip:
*
Recipient Type:
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Charity
Qualifying School
Qualified Access Program
EIN Number or County District School Number
*
Describe Your Non-Profit Organization:
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Include a short description of your organization and its purpose
Contact Information
Contact Name:
*
Contact Phone:
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(
)
-
Contact Email Address:
*
Other Information
Describe how your organization will use the computer equipment:
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What are your computer requirements (type, quantity, speed, memory, etc.)
*
Acknowledgement
I understand that Westchester PC Renew cannot ship or deliver computers. If approved, I agree that it is our responsibility to arrange for pickup:
*
yes
Authorized Representative Name:
*
Date:
*
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