Summary: USF RADIOISOTOPE ORDER
FAX NUMBER: 974-5938
INSTRUCTIONS: To avoid any delay in the processing of your radioisotope order, please
fill out this form in its entirety. Make sure you have entered a PURCHASE ORDER
NUMBER and that this order is SIGNED BY THE RADIOISOTOPE PERMIT HOLDER.
Also, if there are any special instructions be sure to include them in the space provided. For
fastest service fax the completed / signed order to 974-5938.
PLEASE Type or PRINT CLEARLY!
DATE ORDER PLACED:
RADIOISOTOPE PERMIT #:
RADIOISOTOPE PERMIT HOLDER:
PURCHASE ORDER NUMBER:
µCi ACTIVITY ORDERED:
DELIVERY DATE TO LAB:
NOTE: ASAP could mean an extra handling charge. Use a specific date.
DELIVER TO BLDG & ROOM #: