IT Ordering Form BSOL

Consent

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

Yes, I give permission to store and process my data

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

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

Department & base location *

GP Practice / Health / Medical Centre Name *

Please enter the name of the facility you work at

Surgery NACS Code

Please enter your surgery NACS code

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

Order details

Please enter the Printer Model

Enter the printer model so we know which printer tray to order.

Other Hardware

Please use this field when the hardware you wish to order isn't listed in the catalogue, e.g. Check-in Screens.

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.

Any additional information