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

For Staffordshire GP/Practice IT Orders requests please submit a GP IT Equipment Request via the task options on SMT – https://smt.sshis.nhs.uk/#/login.

For Staffordshire Corporate IT Order requests please email Angela.Hancock@staffsstokeccgs.nhs.uk

Please note this CCG will not fund the purchase of Colour Printers

Please note, the ICB do not order Apple products.
For Adobe licenses, please email Simon.Elliot@nhs.net
For mobile devices, please use the Mobile Device form - https://itservices.midlandsandlancashirecsu.nhs.uk/forms/mobile-device-form

For all other orders, please click here.

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

Department & base location *

GP Practice / Health / Medical Centre Name *

Please enter the name of the facility you work at

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 *

Budget code to be used (inc. subjective) *

Budget holders name and email address *

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

Delivery Information

Name of recipient *

Telephone number of recipient *

Which location should the order be delivered to? *

The address you add on this form will be shared with a third party for delivery purposes. If you are NOT happy sharing your home address for this purpose we are unable to deliver to it and instead you should enter your organisations nearest IT support site address.

Home address *

Any additional information