User Fees Authorization Form

How to fill in the Form

Click here to open the User Fees Authorization Form

The first 6 form text fields contain information about the user.
(AMC/VU username should be equal to the username you use for our scheduler https://agenda.cellularimaging.nl )

The next 3 text fields contain information about the Cost Centre (kostenplaats) or WBS

  • Cost Centre or WBS  (kostenplaats/WBS)
  • Email address for the invoice (factuur)
  • Name of Authorized Signatory (tekenbevoegde voor de kostenplaats or WBS)

The last text field should be filled in by hand after printing and contains the signature of the Authorized Signatory.

Do not forget to select one or more of the checkboxes ALM (Advanced Light Microscopy), EM (Electron Microscopy) or Flow (Flow Cytometry) for which the user will be authorized. A new form can be send later if a user needs authorization for another section or sections of our facility.

Print
Click on PRINT to print the form.

Let it sign by the Authorized Signatory

Scan as PDF
Use your multifunctional printer/scanner

Send it by Email
Send as email attachment to Claudia Rhebergen:
with subject: Signed – User Fees Authorization Form – Core Facility Cellular Imaging

Print Friendly, PDF & Email