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Computer Request Form

Requests for computers are processed on the basis of need, submission date, and when computers become available. To begin the process fill out the form below and a representative from Indigenous Society will contact you shortly.
* Required

First Name *

Last Name *

Organization Name

Email Address *

Street Address

Suite/Apt.#

City

State

Zip

Telephone Number *
( ) -

Select type of computer
equipment needed
(use the "ctrl" key to select multiple items):

Quantity

Brief description of your Organization and how the computers would be used::


 

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