Application for Equipment

Requests for individuals should be made by third-party referral (not a relative). Examples of third-party referees include charities, government departments or initiatives, community groups, community or social workers, schools, churches or church groups or local councillors.

Please read the Equipment Receipt and Disclaimer that recipients must sign on receipt of equipment. (Updated 27/7/21)

All information provided will be treated in confidence in accordance with our GDPR Policy.
We may ask for evidence of eligibility.
The final decision on applications lies with the PCrefurb Trustees.

This form is to apply for equipment for residents of Tameside and the High Peak of Derbyshire.

Please read information on the geographic areas we cover.

Delivery time
Although we will always endeavour to provide equipment as quickly as possible, we cannot guarantee a time-scale for provision. If the need is urgent, please let us know.

Current equipment stocks

Desktop systems

Active equipment referrals in progress:

24th March 2025

more than 30

- Step 1 of 4

Is your client a job seeker? *

If your client is able to access publicly available PCs at Libraries and Job Centres then please consider that as an alternative to requesting equipment from us. If your client has any additional needs or difficult circumstances which mean that a device at home is the only appropriate option then we are very happy to try and help. We ask you to differentiate due to the enormous demand on our services.

Referrer Details

Which Organisation are you referring from? *

External organisation
The Bureau
PCrefurb (internal staff referral only)

Referrer Name *

First

Last

Title (Mr, Mrs, Ms, Dr, etc.) - (optional)

Referrer Pronouns (optional)

Name of the Referral Organisation *

Referral Organisation Address *

Address Line 1

City

State / Province / Region

Postal Code

Referrer Job Title/Connection with Client *

Referrer Email *

Confirm Email

Referrer Phone Number

Client Details

PCrefurb internal client referral

Client Name *

First

Last

The person that will use the equipment

Title (Mr, Mrs, Ms, Dr, etc.)

Client pronouns

Preferred Name

Client Address *

Address Line 1

City

State / Province / Region

Postal Code

Client Date of Birth *

Ethnicity *

Gender *

The Client is a school or college student *

The first port of call for devices should be the student's school/college as the body responsible for meeting their educational needs, including provision of alternative work if devices are not available. If, as Referrer, you feel there are exceptional extenuating circumstances please provide details below.

Client Email

Confirm Email

Client Phone Number

Agreement *

The Client has read the Equipment Disclaimer (see above).

Equipment Details

Main reason(s) for request *

Improved employment prospects / job searching
Training / education
Finance / household management
Social interaction and support activities
Management of health needs
Other

In order to support this application, please briefly explain how the Client will benefit from receiving equipment. *

Does the Client have access to a broadband or WiFi connection to access the Internet? *

Yes
No
Other (please explain below)

Which Operating System? Please consider asking for ChromeOS Flex rather than only Windows. This is a lightweight, fully-featured Google-based operating system. Read more about it here...

Equipment preferences (subject to availability). Select all that would be acceptable. *

Desktop system (WiFi capable) - Windows (Microsoft)
Desktop system (WiFi capable) - ChromeOS Flex (Google)
Laptop - Windows (Microsoft)
Laptop - ChromeOS Flex (Google)
Tablet
SIM card - free calls, texts, data for 6 months from activation (give quantity required below)
Other (please explain below)

Please contact us if you need more information about these options. We can provide compact desktop systems.

Optional payment - For a Microsoft Windows computer or laptop we very much appreciate a donation of £10 to cover the cost of the Windows Licence. Is your Client willing and able to contribute?

Optional payment methods *

Yes - cash payment on delivery
Yes - online payment via our website after receipt
Not currently – client has the option to pay online via our website in the future

Limited access to technology *

I, the Referrer, confirm that the Client does NOT already have access to usable equipment, either their own or borrowed, including at a public facility, to meet their needs.

The Client that will use the equipment... *

has a low income and is in receipt of benefits or other financial support
has a disability
other (please explain below)

Tick as many as apply. We reserve the right to ask for evidence to support these choices.

Collection/Delivery - direct contact with the Client *

Does the Client agree to PCrefurb contacting them directly to arrange collection/delivery? PLEASE NOTE: During COVID restrictions, we can only deliver to the doorstep. We comply with all COVID safety regulations.

Can the Client or Referrer collect the equipment from Glossop? ID may be required. *

Client can collect
Referrer can collect
Neither

Any other relevant information

Information cannot be changed beyond this point. Click Next to proceed to the Declaration and to SUBMIT this Referral.

Referrer Feedback Agreement and Declaration *

The Referrer agrees to give feedback to PCrefurb not later than six months after equipment has been provided to confirm it has been used for its intended purpose. When you SUBMIT this form you, the Referrer, confirm that the information given is true, complete and accurate. If applying on behalf of an individual, you confirm that you are authorised to do so.

GDPR Agreement *

I consent to this website and PCrefurb storing the submitted information so PCrefurb can respond to this Referral. The referred client agrees to PCrefurb processing the submitted information in order to respond to the referral.

Name

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