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Computer Equipment Request Form


Only schools and non-profit organizations that are 501(C)(3) qualified and located in Westchester County are eligible to complete this form. Completing this form does not guarantee inclusion on this site. Westchester County reserves the right to edit and select all entries.
Please provide the following contact information:
(*) Indicates required field

Organization Name*

Street Address*

Address (cont.)

City*

NY

Zip/Postal Code*

Contact Full Name*

Title

Work Phone*

914-

FAX

914-

E-mail*

URL

Non-Profit
501(C)(3)Tax Exempt No.*

Please indicate your agency's mission statement*:
Please provide information about your agency's computer equipment needs:

To submit this form, you must enter the random verification code in the field below.