Licence Application - National Healthcare Product Catalogue

Company Address Information

1. First Name

2. Last Name

3. Organisation / Company Name

4. Address

5. Job Title

6. Phone No

Please provide a valid phone number.

7. Sector

8. Email

Please provide a valid email address.

9. Website

10. IPU Member

Yes No

Reason for request

11. Purpose of NHPC Use

Please provide details of how your company will use the NHPC file.

If multiple users within your company will use the file, please specify how each user will use it.

12. End User Qualifications

Provide the qualifications of each end user (e.g., doctor, nurse, pharmacist). Please specify any other relevant qualifications.

13. Reproduction or Distribution of NHPC

Will the NHPC file be reproduced, copied, edited, published, transmitted, modified, distributed, altered, downloaded, incorporated with other materials, or passed on to a third party?

If Yes, please provide further details. This information is required to incorporate authorised use and associated fees into the licence agreement.

14. Site Details

Please list ALL the locations where the NHPC will be used.

15. Network Access

Will the NHPC be accessed over a network (i.e., one site with multiple users)?

16. Number of End Users

Specify the total number of end users who will have access to the NHPC.

17. Purchase Order Number

If your company uses a Purchase Ordering System, please provide the Purchase Order Number.