Bonded Stock Call Off Form

Consent

By completing this form you consent to us storing the data *

Yes, I give permission to store and process my data

Requestor

Name *

Telephone number *

Email address *

Base location *

Call Off / Order Details

Stock Organisation *

Birmingham and Solihull ICB

Black Country ICB

Cheshire and Merseyside ICB

East Cheshire NHS Trust (ECNT)

Herefordshire and Worcestershire ICB

Lancashire and South Cumbria ICB

Midlands and Lancashire CSU (MLCSU)

Shropshire, Telford and Wrekin ICB

PO number *

Supplier (if known)

Item name / description *

Quantity required *

Who is the project lead?

Add Another

For call offs / orders of more than one item please use add another.

Delivery Recipient

Contact name *

Telephone number *

Preferred date for delivery *

Please note:

Requests submitted before 13:00 may be delivered on the following working day.
Small volume orders are expected to arrive within 48 hours of placing the request with the supplier (delivery is between 09:00-17:00).
Larger quantities will require a minimum of 72 hours' notice.
Requested delivery dates cannot be guaranteed, please ensure your request is placed in advance to allow timely delivery.
Please update the Sostenuto ticket when the delivery has arrived and has been quantity checked.
The requestor should ensure there is sufficient capacity and resource at the delivery location prior to requesting call off.

Other *

Please include full postal address for site. Please note that sending stock to a non-IT location requires appropriate asset tagging and updating of asset register by relevant staff member responsible for equipment

Any other information