Computer Application

Purchase Information

To purchase a computer from Computers for the Blind, please fill out the following order form. You will choose the configuration of your computer, and any add-ons that you need. After you submit your order, it will be reviewed by a member of our Customer Service Team, and you will receive a call from us to complete the order. To purchase a computer from us, we do require a doctor's note or equivalent document, that indicates your vision level. You can submit that document with this form, or send it to us when we contact you. When you complete this form, you will be given a cost estimate for your purchase. Do not submit payment for this price until you have been contacted by our team member as you may be subject to sales tax, and we also have grants that could lower the price of your purchase. You will be given your final price by our team member.

To see our configuration and price guide, click this link.

First Name Last Name Email Address Phone Number Address City State Zipcode

Please check any of the following that apply to you. This helps us determine your eligibility for grants and discounts.

Purchased a computer from us before Current Student Veteran SSI Recipient SSDI Recipient

Please select the desired computer configuration below

System Configuration Accessibility Software Order Price Estimate

CFTB Computer Application

Purchase Information

Please check any of the following that apply to you. This helps us determine your eligibility for grants and discounts.

Please select the desired computer configuration below

Please select any options or upgrades desired below.

Please enter any other imporant information we need to know.