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Sterilization Process Order Form

We’re ready to provide the fastest sterilization services.

Please call if you require immediate assistance: 303-531-1238
or email: sterilization@boulderiq.com.

Company Name

Street Address

City

State/Province

Zip

Contact Name

First Last

Email

Username

Phone

Email for Certificate of Processing and Shipment Tracking (if different)

Shipping

Return Shipping Method

Fed Ex

UPS

Pick-up

Return Shipping Speed

Overnight

Two-day

Ground

Payment

Pre-pay + add

Account number

Account Number

Ship To

Address Above

Different Address

Different Shipping Address

Service Requested

Service Level

Standard (5 business days)

48 hour Expedited (add'l fee)

24 hour Expedited (add'l fee)

Return By

MM slash DD slash YYYY

Sterilization Method

Ethylene Oxide (EO)

Chlorine Dioxide (CD)

Cycle Type

Production - Validated cycle, sterilizer, and load configuration required. BIs included. Add Cycle Spec ID below. Cycle spec ID must be provided for production sterilization.

Cycle Spec. ID

R&D/Engineering cycles. Please indicate 1x or 2x. BIs can be added by request. Standard cycle parameters listed on pg 2. Custom parameters available by request.

Non-Production

1x

2x

R&D/Engineering cycles. Please indicate 1x or 2x. BIs can be added by request. Standard cycle parameters listed on pg 2. Custom parameters available by request.

Production - Validated cycle, sterilizer, and load configuration required. BIs included. Add Cycle Spec ID below. Cycle spec ID must be provided for production sterilization.

Items to be Sterilized

Product Name/Description

Part Number

Revision

Quantity

Lot Number

Item to be Sterilized

Product Name/Description

Part Number

Part Number

Revision

Quantity

Lot Number

Product Testing

BIs/PCDs

Sample Quantity & ID

Test of Sterility

Sample Quantity & ID

Endotoxin (LAL)

Sample Quantity & ID

BIs/PCDs

Sample Quantity & ID

Bioburden

Sample Quantity & ID

EO/CD Residuals

Sample Quantity & ID

Other (or no testing required)

Sample Quantity & ID

The Client acknowledges and agrees that it is solely and exclusively responsible for (i) ensuring that the process and specifications are appropriate for the Products, (ii) the validation of the EO/CD cycle, (iii) product sterility, (iv) the integrity of the product packaging, (v) the adequacy of product labeling and (vi) compliance with any and all FDA or other regulatory requirements.

Yes, I agree to the Disclaimer

Authorized Representative

Title

Date

MM slash DD slash YYYY

Untitled

First Choice

Second Choice

Third Choice

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> Sterilization Services
> Ethylene Oxide
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> Assembly and Packaging
> Design, Engineering, Manufacturing, Regulatory

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Contact Us

Boulder Sterilization
5421 Western Ave.
Boulder, CO 80301

Email us
Phone: 303-531-1238

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SERVICES
ABOUT US
- Facility
- Team
RESOURCES
CONTACT
STERILIZATION ORDERS