The Indigenous Society

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::

Desktops
Laptops
Monitors
Printers
Software