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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: