Instrument Shipping Form

Your Details

Company Name(Required)

Ship To Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Fax

Email(Required)

Contact Name / Name for Certificate(Required)

Billing Address(Required)

Street Address Address Line 2 City State ZIP Code

Payment Method

PO#

Other

Calibration Due Date Cycle Requested(Required)

3 months

6 months

12 months

Instruments Being Shipped

Instrument Info

Instrument Model

Instrument Serial Number

Probe Model & Serial Number*

Requested isotope Efficiencies*

Calibration

Repair

Special Work Requests

You may include up to 10 instruments per form.

*Calibration includes 2 efficiencies if applicable and one probe per meter. Additional efficiencies and probes are $12.50 each.

Common Battery Replacements - Approved(Required)

Yes

As Needed - $3.00 each

Repair Approved up to $

By providing an amount here, RSCS will perform repairs up to the specified amount as needed. Any repairs over that amount will be quoted.

Special Return Shipping Comments

NOTICE: RSCS ships via UPS Ground without insurance. Please indicate the desired carrier, method and the value if you would like insurance added.

Terms

RSCS Terms and Conditions are located at www.radsafety.com

Instruments are calibrated in accordance with ANSI 323AB:2013 of ANSI N13.27-1981

The reported expanded uncertainty of measurement is stated as the standard uncertainty of measurement multiplied by the coverage factor k such that the coverage probability corresponds to approximately 95%. In tolerance conditions reported on calibration certificates are based on test results falling within specified limits with no reduction by the uncertainty of the measurement.