IT Ordering Form Worcester

This form is for requesting additional equipment only. If your request is to replace existing equipment that isn't working, please log a ticket with the IT Service Desk.

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 requesting equipment for a new member of staff you also need to complete the All In One smart form to request the accounts.

Name *

Telephone number *

Email address *

Please enter your email address

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

Order details

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 *

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