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Request Form:
Organization Name:
Upload your logo:
Description:
Your Name:
Type:
Charity
Non-Profit
Churches
Seniors
Schools
Non-Profit Number
Address Line 1:
Address Line 2:
City:
Province:
Alberta
British Columbia
Manitoba
New Brunswick
New Foundland
Nova Scotia
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Northwest Territories
Nunavut
_________
California
Illinois
Massachusetts
New York
Texas
Vermont
Washington
Postal Code:
Country:
Canada
United States
Email Address:
Phone Number:
Purpose Of Request:
Deadline:
As Soon As Possible
2 Weeks
1 Month
3 Months
6 Months
1 Year
Is This Your First Request?
No
Yes
Website
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Requested Equipment:
Standard Desktop Computers
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High-End Desktop Computers
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Standard Laptops
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High-End Laptop
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Laser / Toner Printers
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LCD Monitors
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Projectors
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Comments / Captcha:
Video Request URL
Comments / Special Requests
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