Radioisotope Purchase Form

Orders submitted after 2:00PM will be placed on the following business day. Additionally, please note that delivery dates are not guaranteed as they are subject to disruption and delay based on manufacturer and delivery constraints.

--- Please review all manufacturer safety and handling instrutions. ---

Permit Holder:*
Permit Code:
Requisitioner:*
First Last
ID number:*
Email*
Phone
Location:

*Supply building and room number
Institution:*
- Boston University
- Boston Medical Center
Vendor:*
Catalog Number:*

*Ensure that the corresponding permit possesses the appropriate order and possession limits before placing radioisotope orders.
Radioisotope:
Activity:

*Activity should be denoted in terms of uCi.
Description:
Quantity:*
Fresh Lot:
- Yes
- No
*Please review fresh lot calender(s) to avoid delays in delivery.
BU Cost Center:*

*B.U. Only
BU GL Code:*

*B.U. Only
BMC Activity Number:*

*BMC only
BMC Operating Accounting Unit:*

*BMC only
BMC Detail Account:*

*BMC only
BMC Account Category:*

*BMC only
Notes:
Email

This field is for validation purposes and should be left unchanged.