Analytical Services Questionnaire |
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Please provide the following information to facilitate optimum service.
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| Customer Information |
Contact Name: |
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Company/Institution Name:
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Country: |
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Time Zone: |
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Address: |
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City |
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State |
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Phone: |
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Email: |
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Fax: |
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| Type of Business |
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| Analysis Information |
Describe in length the type of information you require.
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Describe any regulatory guideline you wish to be applied
(cGLP, cGMP, USP, other (specify)).
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Would the service require any legal documents in place to proceed
(CDA, MTA, Service Agreement, Formal Quote for Service, other (specify))?
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Provide range or estimate of analyte concentration(s) you expect
(attach references to similar information if readily available.)
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| Sample Information |
Describe in length the sample(s) from which information is required .
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Amount of sample available.
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Physical state of sample (solid, solution (aqueous or solvent), oil, capsule, tablet, other).
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Provide any known hazardous information about the sample.
(chemical, biological, environmental, other (describe)).
Provide MSDS if available.
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Is an extraction or sample preparation require (yes, no, don’t know).
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Describe storage conditions for sample
(refrigeration @ 2-8° C, freezer @ -16 to -24°C, -80°C, other).
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Do you wish the sample to be returned (yes, no)?
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If yes, how would you like it returned? Shipment by courier requires a return account #.
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| Method Information |
Specify the type of method you wish to be used. Attach references if readily available.
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Do you require consultation on available methodologies to provide expected results?
(yes, no)
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Analytical Services