WPCUG
Online Application for a Personal Computer or Equipment
from
Westchester PC-Renew Project

For Non-Profit Organization Use

Fields in red are required, all others are optional

 

Institution Name:

Address:

City:        State (XX)        Zip (XXXXX):

Contact:       

Phone (XXX-XXX-XXXX):     Extension    

Email:

Recipient Type: Charity         Qualifying School         Qualified Access Program

EIN number or County District School Number:

Please describe your non-profit organization (type as much as necessary here):   
Please describe what your organization will use the equipment for (type as much as necessary here): 
What are your computer requirements (quantity, speed, memory, etc.)  (type as much as necessary here):

Will you need a Modem   or  a Network Card (choose one)

I understand that Westchester PC Renew cannot ship or deliver computers. If approved, I agree that it is our responsibility to arrange for pickup:        

Click the Submit button to send your application. Please click only once.

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