| 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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