NEW MEXICO TECHNET

COMPUTER EQUIPMENT DONATION ONLINE REQUEST

Fill out this form and click the Submit Request button below to submit your request electronically or click here to display a printable form. Print the printable form, fill it out and mail it to the address indicated at the bottom of the form.

Organization:

Address:

Contact Name and Title:
Technology Coordinator/Superintendent:

Telephone: Fax:
Email Address:

Equipment Requested:

Current Equipment Available in your Organization:

Technology Plan. How do you intend to use the equipment donated to your school or organization?
NOTE: If your Technology Plan is too long to enter here, please type "Our Technology Plan will be mailed to you." and mail it to Kathy Bruha at the address shown below.

After you click the Submit Request button, a summary of your request will be displayed. Please print this summary for your records.

This form will be forwarded to: Kathy Bruha
Intel, RRT-79
4100 Sara Road
Rio Rancho, NM 87124		 Document URL -- http://www.nedcomm.nm.org/req-form.htm
Last modified: January 16, 1998