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LOCK BOX REQUEST FORM

To order a lock box, please fill out and submit the following form. Lock boxes are clear acrylic. They may be picked up at our lab in 421 ANAT/CHEM between 10:00 a.m. – 11:00 a.m. or 2:00 p.m – 3:00 p.m. The price of the box will be charged to your account. If you have any questions please contact Eileen Normoyle at 215-898-2134. As a reminder, all stock material must be locked when in storage. The lock box must be secured to the refrigerator/cabinet.

* Licensee:
* Contact Person:
* Contact’s Phone #:
* Contact’s Email:
* Business Administrator:
* BA’s Phone #:
* Mailing Address:
* Institution:
UNIV HUP CHOP WISTAR
* Department:
* Account Number: - - - - - -
* Use:
Radioactive Material Select Agent
* Lock Box:
Small Lock Box ($108.00 - Inside dimensions : 5"W x 5"D x 5"H)
Large Lock Box ($121.00 - Inside dimensions : 12"W x 6"D x 5"H)
Restrainer ($40.00)
(small and large lock boxes come with a restrainer (the price of the restrainer is included)).
According to the manufacturer’s specifications, lock boxes are suitable for long-term storage as low as –20°C. Lock boxes rated for lower temperatures can be found at www.rpicorp.com.

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