IT Ordering Form

Consent

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

Yes, I give permission to store and process my data

If you are a member of the organisations Birmingham and Solihull or Birmingham and Solihull GP then please complete this BSOL specific IT Ordering Form instead.

If you are a member of the organisations Hereford and Worcester ICB or Hereford and Worcester GP then please complete this Hereford and Worcester specific IT Ordering Form instead.

If you are a member of the organisations Cheshire, Warrington, Wirral ICB or Cheshire, Warrington and Wirral GP then please follow this C&MICB specific guidance instead

Locality *

Cheshire and Merseyside

Staffordshire and Shropshire

Lancashire

Midlands

Your Details

If you are you a new member of staff you also need to complete the All In One smart form to request your accounts

Name *

Telephone number *

Email address *

Please enter your email address

Order details

Description of requirement *

Please detail any network points or hardware or software required – for example licenses for new PCs/laptops

Quantity required *

Add Another

For orders of more than one item please use add another and you can select another item to order.

Cost Approval

Justification for request *

Please attach your supporting documentation, i.e. "cost approval email", to support your request

Delivery Information

Name of recipient *

Telephone number of recipient *

Any additional information