Arizona StRUT | Computer Recycling & Remanufacturing

Computer Request Form

If your are a qualified non-profit organization in Arizona, and would like to request an equipment contribution from AZStRUT, please complete the following form for consideration of your request.

Standard computer configuration:

Minimum RAM will be 512MB
Minimum Hard Drive will be 20GB
Operating System will be Windows XP
Standard NIC will facilitate network / internet connection.

Organization or School Name:			Employer Identification #

Is this a 501(c) Non-Profit Corporation?		Yes No

Address:

City:	State:	Zip:



Primary Contact Name	Phone:		Email:


Secondary Contact Name:	Phone:		Email:


Referral Information:

# of Computers Needed:
Check here if a modem is required for Dial-up:
Have you previously received computer equipment from AZStRUT?			Yes No
If yes, when and what items were requested?