Request 4 Computers

By filling out this form, you confirm that your organisation agrees to Computers 4 Africa’s Terms & Conditions (please ensure you have read these before you submit any donation request). 

I confirm I have read and agree to C4A Terms and Conditions 

Please fill out the form with as much detail as possible including an email address which enables faster processing.

Request Made By:

Your Name:
Organisation:
Position in Organisation:

EU organisation (if applicable)

Contact Name:
Organisation:
Address:
Postcode/Zip:
Country:
Website Address:
Telephone:
Email:
Registered Company Number:
   

Is this a registered charity or non-profit organisation (Please Specify)

If the organisation is a Registered Charity or non-profit organisation:

What Is Your Registration Number?
Where Are You Registered?

End User Organisation:

Contact Name:
Organisation:
Address:
Postcode/Zip:
Country:
Website Address:
Telephone:
Email:
Absolute Location:  
Latitude:
Longitude:

What does your organisation do?

Requested Equipment

What will the computers be used for?
Please provide specific, detailed information or we cannot process your request. 

Who will be responsible for the computers?

Are there suitably qualified persons to supervise the computers? If so who and what qualifications do they have?

What facilities are in place for the computers (building, electricity, security)?

Computers 4 Africa Pricing Structure

please click here for pricing information.

Please indicate the total number of PC's required:

  Category Number
Platinum
Gold
Silver

Collection date and declaration of accuracy

Your preferred collection date:

Please be aware that dispatch of equipment will only take place once cleared payment has been received.

N.B.  BENEFICIARIES ARE REQUIRED TO PICK UP CONSIGNMENTS FROM OUR AGENT IN THEIR COUNTRY

I hereby confirm that all the details given on this form are correct to the best of my knowledge and I understand that providing inaccurate or misleading information may lead to Computers 4 Africa disregarding my request.

I Agree

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