Name of Charity: (or health or education organization)

Charitable Registration Number: (if applicable)

Contact Person Name:

Phone where you can be reached on the Saturday of the event:

Fax:

Email:

Equipment requested: (be as specific as you can be)

1. I understand that Clean North makes no guarantees that the equipment I've requested will actually be available, because they are dependent on the equipment that comes in to the recycling event and cannot be certain of what equipment will be dropped off for reuse or recycling.
2. I understand that Clean North doesn't guarantee that the equipment they turn over to me will work for what I want to do. Clean North volunteers have tested it and found it to be working at the time of the computer recycling event, but they cannot guarantee that it will work later.
3. I understand that Clean North cannot turn over software without licenses and that it may be difficult to obtain appropriate soft- ware for older computer equipment.
4. I understand that Clean North is not able to provide help with hardware or software issues that may arise after this equipment is turned over to me.
5. I understand that I must make arrangements to pick up equip- ment at the computer recycling event.