Request Form – Organisation

Organisation Name (required)

Type of Organisation:
 Charity Non-Profit Educational

ABN Number (required)

Contact Name (required)

Contact Title

Your Email (required)

Please indicate the quantity of standard build computers with Microsoft software that you are interested in:
Desktops Laptops

Teacher in a Box server for classroom or library or community centre
Laptop Desktop 
(See our Teacher in a Box project page for more information)

Please outline the purpose for which these computers will be required

Invoice to:
 My Organisation Our Client

Organisation Address:
Street Address 1

Street Address 2

Suburb

Postcode

Who will collect the computer?
 Organisation's Representative Our Client

PLEASE NOTE: If a separate invoice is required in each client's name then a separate application for each client will need to be submitted and the Invoice To fields completed. If not, a single invoice will be issued to the organisation and all components on the order will need to be collected at the same time.