Account Application for Trust Administrator

"*" indicates required fields

Please fill in your details, all fields are required and cannot be submitted if any information is missed.

All information submitted to us in this application form must be true, complete and accurate

If it is discovered that the information submitted has misinformed us then your application will be rejected.

Any Trust Administrator assigned on behalf of a Trust as a result of false or inaccurate information will be deleted and all permissions associated with the role of Trust Administrator will be revoked.

Please tell us about you

Title*

First Name*

Last Name*

Email Address*

Enter Email Confirm Email

Telephone Number*

Trust Name*

Job Title

Department*

Position held for?*

Online catalogue ordering user name*

DOH code*

Tell us about your finance contact

Director of Finance – Full name must be filled in.*

Director of Finance email address*

Director of Finance telephone number*

Select your supplying NHS Supply Chain depot(s)*

Alfreton

Bridgwater

Gorsey Point (Runcorn)

Maidstone

Normanton

Rugby

Suffolk Park (Bury St Edmunds)

What is the abbreviation for a General Practitioner?

(Please enter two letters only – this is just an additional check to ensure our form entries are submitted by humans)

Declaration*

I confirm that all information submitted in this application is true and that I fully understand the information above.

Comments

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Account Application for Trust Administrator

Please tell us about you

Tell us about your finance contact

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