Untitled Document


Enquiry# (to be inserted by EBSB only)

PROCESSING REQUEST FORM

Requestor Details	Date

1. Name of Company
2. Address
3. Postcode
City
4. Office Tel
Office Fax
5. Email
6. Contact Person
Handphone
7. Is this the first time you are requesting for this service?	Yes; go to Qu. 9
	No; go to Qu. 8
8. Has a dose audit been carried out by ELECTRON BEAM on this product?	Yes; please provide Dose Audit Report Number and go to Qu. 17
DAR#
	No; please continue to Qu. 9
9. Description of Product to be irradiated Please also describe the material the product is made of.
10a.What is your current mode of sterilisation?
10b.What is the minimum dosage required? (kGy)
10c. What is the maximum dosage allowed? (kGy)

Please provide Packaging Information in order to assess your products suitability for ebeam irradiation.

11. Are there Inner Boxes?	Yes; continue to Qu. 12
	No; please go to Qu. 13
12. Dimensions (L x W x H in mm) :
13. Shipping carton?	Yes; continue to Qu. 14
	No; describe packaging method below
	Go to Qu. 15
14. Dimensions (L x W x H in mm) :
15. Weight of carton / bundle? (in g) :
16. How many cartons / bundle on a pallet (if palletised) :
17.What is the Total Overall Quantity of Products to be irradiated in this Enquiry?
Qty in cartons
18. Is the 48TurnAround™ service required? (only for products with Dose Audit Reports)	Yes
	No

Name of person who filled this form:
Contact No:
Date :


Notes:
1. Please note that certain items of packaging configuration cannot be irradiated by e-beam due to penetration depth limitations. 2. Electron Beam will assess the information you provide in the Processing Request Form and provide you with a response within 48 hours. 3. On your acceptance of the quotation and the receipt of your Purchase Order, Electron Beam will schedule a Dose Audit Validation (if required), or a processing slot if there is already a prior Dose Audit Report. 4. A Dose Audit Validation has to be carried out on your product to determine the e-beam irradiation parameters prior to Electron Beam accepting your order for processing. 5. The outcome of the Dose Audit Validation may indicate a requirement for modification of your packaging dimensions and method before your product can be e-beam irradiated. 6.The Dose Validation process is a destructive process and your products will not be reusable once it has been used to carry out a dose validation. 7.For this reason, please allow a small percentage of your product to be dose validated prior to e-beam irradiation. The actual amount will be advised by Electron Beam. 8.Electron Beam assumes no responsibility for claims of loss of time and/or order cancellation should the Dose Audit Validation determine that your products cannot be treated in their current form.