Low Cost Computer Application

INSTRUCTIONS

Please complete this form and be sure to have the referral section completed. Once submitted, please allow us time to process the application and connect with the referral person. We will contact you once the request has been approved.

COST:

Desktop Package: $50.00
Includes a desktop computer with Windows 10 operating system, monitor, keyboard, mouse, power supply cord and video cable

Laptop Package: $100.00
Includes laptop with Windows 10 operating system and power cord.

Fee must be paid at time of computer pickup. Credit/debit cards preferred, cash also accepted.

INSTRUCCIONES

Complete este formulario y asegúrese de completar la sección de derivación. Deje tiempo para que procesemos la solicitud. Nos pondremos en contacto contigo una vez aprobada la solicitud. La dirección de recogida es:

EL PRECIO:

Paquete de computadora de escritorio $50.00
Incluye una computadora de escritorio con sistema operativo Windows 10, monitor, teclado, mouse, cable de alimentación y cable de video.

Paquete de laptop $100.00
Incluye laptop con Windows 10 y cable de alimentación.

La tarifa debe pagarse al momento de retirar la computadora. Se aceptan tarjetas de débito, crédito y efectivo.

Scroll down to fill out the application

Low-cost computer program

This form is to be filled out by a representative for a student or jobseeker.

Applicant's First Name

Applicant's Last Name

Applicant's Email

Applicant's Phone Number

Applicant's Address

***Referral Information***

School counselor, advocate, or case manager

Referral's first name

Referral's last name

Laptop or Desktop?

Laptop

Desktop

Organization

Referral's Email

Referral's Phone Number

Who will pick up the computer?

Applicant

Referral

Additional information

COMPUTERS NOT PICKED UP WITHIN 60 DAYS WILL REQUIRE A NEW APPLICATION BE SUBMITTED

NEW!

Low Cost Computer Application

Scroll down to fill out the application

Low-cost computer program