http://www.techaccesspa.org

 
5900 N. 5th St.
Philadelphia, PA. 19120
Phone: (215) 424-4800 ext. 108
Fax: (215) 424-4805
email: info@techaccesspa.org


PERSONAL COMPUTER APPLICATION

Print this form, fill it in and return it to the address above. Or, you can fax it to the fax number above, or hand-carry it to St. Paul's Lutheran Church, at the above address (Tech Access is located in St. Paul's Lutheran Chruch in Olney).
     
I would like to apply to receive a used and/or refurbished Personal Computer from Tech Access, PA. I agree to donate to Tech Access, PA the amount of EIGHTY DOLLARS to partially defray the cost of the necessary hardware, software and technical expertise and man-hours that went into the machine that I will receive. In addition, I agree to spend a minimum of ONE HOUR of learning experience at Tech Access to learn how to operate my new machine and use the Internet productively.
     
I understand that the personal computer that I receive will contain at least a Pentium II or equivalent processor, a 2 gigabyte hard drive, 64 megabytes of RAM, a modem for connecting to the Internet, a color monitor, a keyboard and a mouse. My personal computer MAY OR MAY NOT come with speakers and a sound card.  My personal computer WILL NOT include a printer, although a printer and printer software might be available for a slight additional dollar donation.
     
Name of Applicant:__________________________________________________________________
     
Address of Applicant:________________________________________________________________
     
Phone Number: Daytime:___________________________ Evening: ________________________________
 
Please list the names, ages and relationship to applicant of ALL members of this household who will benefit from the use of this personal computer (If more space is needed, continue to list names on the back of this application):
NAME: AGE: RELATIONSHIP TO YOU:
     
     
     
     
     
 
TERMS: Your request for a personal computer will be filled in the order in which that request was received. If no machine is available now, Tech Access, PA will notify you as soon as one does become available. Tech Access, PA can make no warranty or other guarantees on the hardware and software that you receive, and you agree to accept this equipment as-is.
 
With your signature below, you indicate that you have read and understand the terms of this application:
Signature:________________________________ Age:_________ Today's Date:_______________


Tech Access, PA, Inc. Publication Number A1012005