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Computer Application Form

Individual Application
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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 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 look at 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 $160. Price depends on Laptop specs. Stock can be limited at times.Desktop Computer: Windows 11 Pro (64 bit). Microsoft Office 2019. Price from $130. 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.

Cancelof
Signature

Clear
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Amount to Invoice
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Computer Application Form