ATI Equipment Recycling Program

Equipment Recycling Application
ATI Equipment Recycling Program

Adaptive Technology Inc. sponsors an equipment recycling program. We take donations of computer equipment and refurbish the equipment and then make it available to blind and visually impaired residents of Missouri. There will be no charge to the recipient for this equipment. All that we ask is that the recipient completes the Equipment Recycling Application below. All equipment is placed on a first come first serve basis. If you have any questions, you may call 636-262-1383.

Date:
Name:
Address:
City: State: Zip Code:
Telephone:
E-mail:
Date of Birth:
Have you tried other sources for obtaining equipment?
If yes, what source have you tried?
Do you currently own a computer?
If yes, how old is it?
Are you a student?
Are you currently employed?
What type of equipment are you interested in? Please check all that apply.
Computer:
Monitor:
Keyboard:
Scanner:
Printer:
Note Taker:
CCTV:
Other, please describe:
In 200 words or less, please explain how you would use this equipment: