Instructions for Completing:
Isotope Order Form

1. Name:  Enter your name.
2. Email Address:  Enter your email address.
3. Authoree No.:  Enter the 4-digit number assigned to the authoree ordering the isotope.
4. Authoree Name:  Enter the name of the authoree ordering the isotope.
5. P.O. Number:  Enter the Purchase Order Number assigned to your isotope order.
6. Date Ordered:  Enter the date your order was placed with the vendor.
7. Vendor:  Enter the name of the vendor or company with whom you placed your order.
8. Building Name:  Enter the name of the building where the isotope is to be delivered.
9. Room No.:  Enter the room number where the isotope is to be delivered.
10. Amount:  Choose one of two choices from the pull-down menu:

    mCi:  milliCuries.

    uCi:  microCuries.

11. Isotope Type:  Select the isotope from the pull-down menu. If your selection is not listed, choose
    *Other and enter the isotope name in the space provided.