KnowledgeBase's Project CHIP Image

KnowledgeBase's Project CHIP

Project CHIP will acquire, refurbish, and redistribute 200 quality, low-cost used computers to mission-driven organizations during 2003. Please complete this application if you are interested in receiving a donation of refurbished computer equipment from us.


Contact Information

Name: Derrick Brown
Voice: 770.794.1562
Email: derrick.s.brown@att.net
 
   

1.  
Today's Date (mm/dd/yyyy)
 
   
 

 
   

2.  
Organization Name
 
   
 

 
   

3.  
Contact Last Name
 
   
 

 
   

4.  
Contact First Name
 
   
 

 
   

5.  
Organization Address
 
   
 

 
   

6.  
City
 
   
 

 
   

7.  
State
 
   
 

 
   

8.  
Zip
 
   
 

 
   

9.  
Email Address
 
   
 

 
   

10.  
Home Phone
 
   
 

 
   

11.  
Work Phone (Phone 2)
 
   
 

 
   

12.  
Please briefly state your organization's mission.
 
   
 

 
   

13.  
What computer equipment does your organization need (please provide a list)?
 
   
 

 
   

14.  
Is your organization tax-exempt (501c3)?
 
   
  Yes   No
   

 
   

15.  
Do you have the means to transport and/or store more than 10 computers?
 
   
  Yes   No
   





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