How many computers does your school currently maintain? (Please include networked and standalone computers.)
Estimated number of computers you'll purchase in the next 3 years	+
Total network licence count	=
Calculated incentive program value	$

Name of school or institition
Street address
Postal address
Phone
Fax
Number of families in your school

Principal or Head of Institution

Mr     Mrs     Ms     Dr     Prof     Other
Name:
Email:

or Department Head

Mr     Mrs     Ms     Dr     Prof     Other
Dept:
Name:
Email: