Mass Spec Sample Submission Form

Client Information

Name*

First Last

Email*

Phone*

PI or Advisor*

Affiliation (Department/Company)*

Account/Fund to be charged*

General Sample Information

Sample name*

Molecular formula*

Please use "^" to denote superscript numerals and "~" to denote subscript numerals. Example: Barium bromate - dihydrate would be Ba(BrO~3)~2·2H~2O.

Nominal mass*

For Dry Samples

Sample quantity

Units

mg/ml
µ/ml

Solubility

H20
MeOH
ACN
Other....

For Wet Samples

Sample concentration

Units

mg/ml
µ/ml

Solvent

Possible impurities

Percent purity

Safety Considerations

Please check all conditions that apply to your sample.
Note: No radioactive samples will be accepted for analysis.

Safety considerations

None
Carcinogenic
Explosive
Flamable
Irritant
Toxic
Unknown
Other...

Special Handling Requirements

Special handling requirements

None
Air sensitive
Light sensitive
Store in refrigerator
Store in freezer
Other...

Analytical Information

Type of analysis

MW determination
Quantitation
Framentation
Other...

Ionization technique

APCI
ESI
MALDI

Spectrum type

MS
MS/MS
LC/MS

Ionization mode

(+) ion
(-) ion
+/- ion

Mass range to scan

Would you like your results emailed to your?

Yes
No