Application for secondhand equipment

(We kindly ask you to print this page, and send the answers by email)


Registration of applicant

Full Name

Job Title

Mobile Phone

Work Phone

Fax

Work Email

Personal Email

Home Address

City

State/Province

ZIP/Postal Code

Country

 

Registration of Organization

Name

Type

Phone

Fax

Website

Facebook

Address

Address

City

State/Province

ZIP/Postal Code

Country

 

 

Please describe your needs:

 

List the articles according to priority

 

Is it replacing other equipment?

 

Are you newly established?

 

Who and how many will benefit from this?

 

How will you handle maintenance/repairs?

 

Which alternative ways could there be to obtain these goods?

 

Describe the major concerns/threats if we go ahead with this project

 

Please document your needs by video or pictures and attach these to the email.