CORD ON-LINE ORDER FORM

PLEASE COMPLETE EACH ITEM

Today's date:

Name of person who will work with the radioactive material:
Last Name: First Name:

Lab phone number,
[Biochem Addition - Please include your extension numbers]
(CORD often needs to contact you)

Principal Investigator / Major Professor's name:
Last: First:

Radionuclide:

Number of vials or kits requested:

Activity per vial or kit requested (must be in milliCurie units):

Catalog number of compound or kit:

Vendor name:

Name of compound or kit, PLEASE BE SPECIFIC :

Cost Center Number: SD

Delivery Address - room number and building :

Any special instructions that CORD needs to know about, i.e. any of the following:
FRESH LOTS, DATE NEEDED, SPECIAL VOLUMES - these must be given in MILLILITERS:

You may when completed, or if you need to make corrections.

Last updated: June 11, 2009