+1 (204) 949 2430
316 Tache Avenue Winnipeg, Manitoba, Canada R2H 2A4
NOTE: This form is
needed if you are filling out the APPLICATION FOR IDEVICE
*Request for Quote Form – quote provided for
(no setup and/or training) *
*Application for iDevice – application for equipment and our services (setup and/or training)*
Name of Requester
Funder (quote will be submitted to)
Will you require the additional warranty for the equipment?
Is this a replacement device?
Type of Case
Otterbox Utility Series carrying strap
EVA with shoulder strap (Ultimate II)
Do you require this system to be shipped to a location outside of Winnipeg?
All systems are picked up from OARC unless shipping has been approved by a funder
If yes, please provide the full shipping address
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