Equipment donation form Name(Required) Title Mr.Mrs.Dr.Ms. First name Surname Email(Required) Phone(Required) Address(Required)Address must include postcodeType of address(Required) Business/practice Residential Item being donated(Required) Make and model(Required) Is the item in working order?(Required) Yes No n/a Approximate size(Required) Approximate weight(Required) Are stairs involved?(Required) Yes No Other Is parking available?(Required) Yes No Other Ready to go?(Required)Is the equipment disconnected (ready to go)? Yes No Other Consent(Required)Data Protection Act: Dentaid the Dental Charity is committed to ensuring that your privacy is protected. The information you provide will be held in accordance with the Data Protection Act and will NOT be shared with any other organisation or individual unless specifically required by law For the purpose of the Data Protection Act, the data processor is Dentaid Ltd, 116 Commercial Rd, Totton, Southampton SO40 3AD Please tick the following box and fill in the date to give your agreement for Dentaid to keep you updated with our charitable work both in the UK and abroad. I agree to the privacy policy.CAPTCHA
