Computer Recycling of Virginia, Inc.

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Request a Donation

Request a Donation Form

If you would like to request equipment from Computer Recycling of Virginia, please fill out and submit the form below.

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1. Company Name:
2. Contact Name:
3. Address:
4.  
5. City:
6. State: SELECT A STATE Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Oregon Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
7. Zip Code: - (example: 12345 or 12345-6789)
8. E-mail Address: (example: yourname@company.com)
9. Web Site URL: (example: http://www.domain.com/)
10. Telephone: / -
11. Fax: / -
12. Federal Tax ID:
13. Designation: SELECT DESIGNATION Public School Nonprofit 501(c)(3) Charitable Organization Other If "Other", please specify:
14.   Please give a brief but concise description of your program. Include information on the population that your organization serves.
15.   How many computers are you requesting?
16.   What is the intended use of the equipment?
17.   Will you need an operating system installed on the computer(s)? Yes   No
18.   Will you need Open Office installed on the computer(s)? Yes   No
19.   Will you need the computer(s) to be able to connect to the Internet? Yes, Dial-up   Yes, High-speed   No
20. Are there any special requirements that you would like to have considered?
21.   How did you hear about our program?
22. Questions:
23. Verification: Leave this field blank!

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