29th January 1998 - ERNi



APPLICATION FOR A COMPUTER

Please complete this form plus a copy of your DSP Centrelink pension card and a support letter advising how the applicant would benefit from owning their own personal computer.

If you DO NOT HAVE a DSP Centrelink pension card complete this form, attaching a letter from a Health Professional (on an Official Letterhead with Provider Number) stating that the applicant does have a disability, and advising how they believe the applicant would benefit from owning their own personal computer.

Client Information (Name of Child or Adult to receive Computer)

Name: Age:

Address: State: Post Code:

Phone (BH): Home: Fax:

Contact Person

(if applying on behalf Child or Adult): Pension No:

Phone (BH): Home Fax:

__________________________________________________________________________________________________

I wish to purchase a: Desktop Computer with MS Windows and Office incl. (Please Tick)

If you wish to provide any further information please write it below. All information will be kept strictly confidential.

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|OFFICE USE ONLY |

|Approved: |Date Contacted: |Date Taken: |

|Computer No: |By: |By: |

|COA Win 10: |Date to be collected: |Recipient | |

|COA Office 2010: |Phone |Mess |Receipt No: |

|Technician: |Letter | |Paid /Amount: |

|Date Completed: | |Signature: |

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INFORMATION SHEET

We recycle refurbished computers, donated by businesses and other community-spirited organisations and individuals, back out to people, with disabilities (especially children), at a nominal cost.

|PRODUCT |PRICE |

| | |

|PC with Windows Operating System | |

|A Pentium 4 or above Computer with a LCD screen, keyboard and mouse |$30.00 |

|Comes with MRR Licensed Software ( Microsoft Windows 10 & Office 2010), | |

|2 Product Key Documents | |

|2 Certificates of Authenticity (attached to the PC) | |

|CD-ROM Drive | |

|Speakers | |

|All goods to be picked up from ERNI or your own Courier arrangements. | |

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Our Computers come with a 3 month Warranty. If hardware fails, it is to be returned to our depot in Ringwood. Please telephone first to make sure a technician is on site. Our volunteer technician will either fix it or replace the defective equipment with another equivalent donated product.

*Please note Warranty will be deemed void if computers are tampered with in any way.

Once the application form and accompanying supporting letter is received, it will be assessed at our next Committee Meeting, and we will notify you of the outcome. Successful Applicants will be able to pick up their computers from our Depot Tuesday or Thursday mornings- 9:30am – 1:00pm.

Computers will be held for a maximum time of six weeks for successful applicants. After that time they will be returned to stock and re-application will be necessary.

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Application Received:

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Revised 01/05/2019

Revised 01/05/2019

0808/2013

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