Computer Application Form

Computer Application Form

Individual Application
Please complete this form if you wish to purchase a computer from Wanneroo Community Men's Shed. We are able to supply refurbished Windows computers to holders of a valid Commonwealth benefits card. These include Health Care, Pension, Veterans, Disability.

Due to Microsoft licensing requirements we are not able to accept applications using Commonwealth or State Seniors cards. We are also only able to supply 1 computer for each card holder in a calendar year.

We do also often have some old refurbished Apple computers for sale from $130 depending upon specifications but it is not necessary to complete a form to purchase one of these. Just come in to our sales office on Tuesday or Friday to see what we have available.
No - I am applying for myselfYes
This form is to be used if you are purchasing a computer for use by one of your clients, customers or staff members for their own personal use.

Do not use this form if you are wanting to purchase a computer for use on behalf your organisation. There is a separate form on our website to use for this.
Organisation Name
If you are purchasing or applying on behalf of one of your clients, please include your organisation name.
Your Name
Your Contact Email
example@example.com
Your Contact Phone
Australian Phone Number onlyFormat: (00) 0000-0000.
No, customer will pay directlyYes - to the Email address aboveYes - to a different Email address
Contact Name for Invoice
If different to Your Name
Email for Invoice*
example@example.com
Reference or PO that we need to quote on the invoice?
Max amount we can invoice
i.e. the most you will pay; we will ask customer to pay the difference
Customer's Name*

First NameLast Name
Customer's Name (old)*
For the PC Licence
Customer's Email*
example@example.com
Laptop Computer: Windows 11 Pro (64 bit). Microsoft Office 2019. Price from $180. Price depends on Laptop specs. Stock can be limited at times.Desktop Computer: Windows 11 Pro (64 bit). Microsoft Office 2019. Price from $160. Price depends on system specs. Stock can be limited at times.Either Desktop or Laptop
Customer's Phone Number*
Australian Phone number onlyFormat: (00) 0000 0000.
Customer's Address*

Street Address

Street Address Line 2

City/suburbState

PostCode
Health Care Card (green)Low Income Health Care CardPensioner Concession CardVereran Affairs Concession CardI am a WCMS MemberOther
Please note that under our agreement with Microsoft we are unable to accept State or Commonwealth Seniors cards or the Commonwealth Seniors Health-care card. Cards like Passports, Immi Cards, Medicare, Student, or Drivers Licences are also not sufficient.
Use this option if you don't have a concession card as listed. If you do have a valid concession card, it is easier for us if you can please upload it.
Please upload copy of your Centrelink Health Care Card or similar. *

Only the image that shows the name and CRN please
Cancelof
Note that, as you are applying for a computer on behalf of another person, you are agreeing to the terms and conditions and signing this form on their behalf. Please ensure that you and the client are familiar and agree with these prior to collecting the computer.
Signature*

Clear
Date*

DayMonthYear
Date
Amount to Invoice
Should be Empty: