DijiRed Laptops for Students
Account name: DijiRed Ltd BSB: 806015 Account: 02024198
Please note to request a device you must reside in Western Australia
Subject
Please select: AgencyPersonal
AgencyPersonal
Agency Name (*if you are an agent requesting on behalf of a client)
Agent Name
Phone Number
Email Address
Name
Date of Birth
Male or Female MaleFemale
Address
Do you/they have an Internet connection at home? YesNo
Name of Internet Provider(ISP)
Are you/they enrolled to study? YesNo
Is this course online? YesNo
Name of Course
Name of School
Year
Any concession eligibility YesNo
If Yes. Type of concession
Are you/they of Aboriginal or Torres Strait Islander origin? AboriginalTorres Strait IslanderOther
Reason for needing a device / Additional information (*Required)
Please attach proof of concession or enrollment here
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