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Donate Computer

Please note that the value of equipment is determined by using the standard ACTLAP Used Computer Evaluator as a guideline.

Contact Information

First Name

Last Name

Phone Number

Fax Number

Email

Mailing Address

Have you previously donated to ACTLAP?

Yes No
If yes, when

Type of Donation

Business

Business Name

Personnal

Equipment List

Computer/Office Hardware

	Quantity	Description
Server
CPU
Monitor
Printer
Fax
Other Hardware

Computer Parts

	Quantity	Description
Memory
Hard Drive
Keyboards/Mice
Other Parts

Application will be sent via email to ACTLAP