Technology Equipment Donation Request
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Requestor Name:
*
First Name
Last Name
Requestor E-mail address:
*
example@example.com
Mailing address of your organization:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Requestor Phone Number:
*
Please enter a valid phone number.
Name of your CEO or Executive Director:
*
First Name
Last Name
Email of your CEO or Executive Director:
*
example@example.com
What is your organization's mission statement?
*
How will this donation be used by your organization?
*
At what location will you be using this equipment?
*
What type of equipment are you looking for?
*
Please Select
Desktop Computer
Monitor
Laptop Computer
Tablet
How many of the above devices are you requesting?
*
Please upload your organization's W-9:
*
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of
Please upload your organizations's 501(c)(3) designation letter:
*
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of
Submit
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