Computer Application Form

Please complete this form if you wish to purchase a computer from Wanneroo Community Men's Shed. We are able to supply refurbished Windows computers to holders of a valid Commonwealth benefits card. These include Health Care, Pension, Veterans, Disability.

Due to Microsoft licensing requirements we are not able to accept applications using Commonwealth or State Seniors cards. We are also only able to supply 1 computer for each card holder in a calendar year.

We do also often have some old refurbished Apple computers for sale from $100 depending upon sepcifications but it is not necessary to complete a form to purchase one of these. Just come in to our sales office on Tuesday or Friday to see what we have available.

Are you from an organisation or company and applying on behalf of a client or customer?

No - I am applying for myselfYes

This form is to be used if you are purchasing a computer for use by one of your clients, customers or staff members for their own personal use.

Do not use this form if you are wanting to purchase a computer for use on behalf your organisation. There is a separate form on our website to use for this.

Organisation Name

If you are purchasing or applying on behalf of one of your clients, please include your organisation name.

Your Contact Details

Your Contact Email

example@example.com

Your Contact Phone

Phone Number

Would you would like us to send an invoice to your Organisation?

No, customer will pay directlyYes - to the Email address aboveYes - to another Email Address

Reference or PO that we need to quote on the invoice?

Max amount we can invoice

i.e. the most you will pay; customer will pay difference

Customer's Name*

For the PC Licence

Customer's Email*

example@example.com

Computer Required*

Laptop Computer: Windows 11 Pro (64 bit). Microsoft Office 2019. Price from $180. Price depends on Laptop specs. Stock can be limited at times.Desktop Computer: Windows 11 Pro (64 bit). Microsoft Office 2019. Price from $160. Price depends on system specs. Stock can be limited at times.Either Desktop or Laptop

Customer's Phone Number*

Customer's Address*

Street Address

Street Address Line 2

City/suburbState

PostCode

Please upload copy of your Centrelink Health Care Card or similar. *

Only the image that shows the name and CRN please

Note that, as you are applying for a computer on behalf of another person, you are agreeing to the terms and conditions and signing this form on their behalf. Please ensure that you and the client are familiar and agree with these prior to collecting the computer.

Signature*

Date*

Date

Amount to Invoice