Computer Equipment Request Form

Request for Computer Equipment
Only schools and non-profit organizations that are 501C3 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* Tax Exempt No(501C3)

Please indicate your agency's Mission Statement:

Please provide information about your agency's computer equipment needs:

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Westchester Access www.westchestergov.com/WestchesterAccess

Westchester Access
www.westchestergov.com/WestchesterAccess