Home Page Equipment Request or Donation

Use this form to make an equipment request or tell us about a donation. We need an email address, contact name and phone number so we can get back to you. Please let us know if you are making a request for someone else.

*Email Address:
*
I am submitting this request for someone else (enter name here):
*Phone:
Please enter your request below by checking one or more boxes, and using the space provided.  
Requesting a computer:
Requesting medical equipment:
I would like to make an equipment donation:
Tell us more about your request:

You can also call (505) 341-7171 to contact BackInUse. If we don't immediately answer, leave a message and we will get back to you by the next day (Monday through Friday).

We accept equipment donations at Adelante's main offices at 3900 Osuna Road NE from 8:00 till 5:00 Monday-Friday. call (505) 341-2000 if you need directions.

We respect your privacy and will never disclose your email address or other personal information without your permission. You will always have the opportunity to stop receiving emails from us at any time.