Donate-IT Request Form
Public form
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Request form
Donate-IT Request Form
Join the waiting list. Staff will contact you when a device is available.
Company website
Personal details
Full name
*
Date of birth
*
Email (optional)
Phone number (optional)
Postal address (optional)
Referred by (optional)
Click to expand
Organisation
(e.g. Jobcentre Plus, Age UK, GP Surgery)
Referrer name
Referrer phone
Referrer email
Reason for referral
Device request
Type of device
*
Feature Phone
Smart Phone
Tablet
Laptop
Desktop
Other
Please describe the device
*
Selecting a phone allows you to also request a SIM card.
SIM required?
-- please select --
Yes
No
Additional notes (optional)
I agree to my personal data being held by Inclusive Bytes for the purpose of receiving a device through Donate-IT. I understand my data will be kept for up to 5 years and I can request erasure at any time.
Privacy notice
*
Submit request