1930 SW 4th Avenue, Suite 104
Portland, OR 97201 77002
Email:
ormesa@pdx.edu
website: oregonmesa.org
Contact: 503-725-4665
INVENTORY / SUPPLY REQUEST FORM
We are hoping to make obtaining supplies for your MESA chapter as easy as possible this year. Use this form to let us know what you need, and we will be in touch.
Advisor Full Name
*
First Name
Last Name
School Name
*
Need to be delivered?
*
Please Select
Yes
No
If Yes, then fill the Address details below If No, advisor should arrange for pickup
Where should we deliver/send the item?
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number in case we have questions
*
Format: (000) 000-0000.
E-mail for shipping confirmation
example@example.com
ITEMS NEEDED:
# micro:bit kits needed
Other items (Provide the item name and quantity required. Example: 2 breadboards and 1 drill)
If you have a specific request from an online vendor, such as Amazon, Home Depot, etc. please include a link to purchase the item
Full Name
*
Signature
*
Submit
Should be Empty: