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Performing Calculations in a Table

Dosimetry Order Form for Simply Locum
Name Address Phone Number
Admin Fee Cost
Initial once only admin fee Normal cost £25 (Simply Locum Discount Applied) £15
Type of Device Annual Fee Number of badges Cost
Instadose+™ £30 per badge per year
Traditional Mail
Back Dosimeters
Monthly Fee Number of badges 2 Monthly Fee Number of badges Quarterly Fee Number of badges Cost
All devices are 'leased' from Mirion. Non return/loss of equipment charged at:
Instadose+™ £35
TLD £20
MeasuRing £10
Finger Stall £10
Eye Dosimeter £10
Refundable Deposit for Instadose+™ Fee to Pay COST
Repayable at end of contract £35 £35
COST OF ALL BADGES
COST OF ALL BADGES+DEPOSIT
VAT @ 20%
TOTAL COST
*COST CALCULATED FROM ITEMS ORDERED ABOVE (Deposit and Setup fee automatically included)
By signing below you are ordering the equipment above and badges below, in accordance with our terms of business.
Signature: Date:
To order badges please complete the order form below - ensuring ALL fields are completed electronically.
Last name First name Email address Type of badge requested eg.
Instadose, TLD, MeasuRing,
eye dosimetry
Badge Colour Blue/Green/
Red/Pink/Orange

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