Chromatography Sample Submission Form
 
 
Please provide explicit information.
 
 
Attention: Samples submitted to JASCO for feasibility analysis should not be toxic in any sense. ANY reactive agents that may trigger sample reaction(s) must be identified prior to sample approval and acceptance for spectroscopic analysis. Sample request and where applicable, Material Safety Data Sheet (MSDS) information MUST be submitted and approved before samples are shipped to JASCO, and a sample submission number (SA#) assigned.
 
Samples submitted to JASCO for feasibility analyses will be examined solely to demonstrate the ability of the instrumental analysis method to provide meaningful spectroscopic results. Submitted samples will be returned immediately after completion of the sample analysis and report generation.
 
Customer Information:
 
 
First Name*
 
 
Last Name*
 
 
 
Company Name*
 
 
 
 
E-mail*
 
 
Phone Number
 
 
 
Street Address
 
 
 
 
City
 
 
State
 
 
 
ZIP/Postal Code
 
 
Country/Region
 
 
 
 
 
 
Name of Sales Representative
 
 
 
 
 
 
 
Section I: Reference Information
 
 
 
 
Sample Name:
 
 
Sample Number:
 
 
C.A.S. Number:
 
 
Structure: (preferred)
 
 
MW:
 
 
 
 
 
 
Section II: HPLC/SFC Conditions
 
 
 
Column
 
 
Flow Rate
 
 
Injection Volume
 
 
Concentration
 
 
Mobile Phase
 
 
Temperature
 
 
UV Wavelength
 
 
Other Detector Parameters
 
 
 
Attach chromatograms if permissible.
 
 
 
 
 
Section III: Method Requested
 
 
 
Check all that apply:
 
 
 
 
Analytical HPLC
 
 
Semi-Prep HPLC
 
 
 
Prep HPLC
 
 
Analytical SFC
 
 
 
Semi-Prep SFC
 
 
Prep SFC
 
 
 
SFE
 
 
SFC-MS
 
 
 
Achiral
 
 
Chiral
 
 
 
Amount Needed:
 
 
 
Purity Requirements:
 
 
 
Recovery Requirements:
 
 
 
Quantity Requirements:
 
 
 
Method Attached:
 
 
 
 
MSDS Attached:
 
 
 
 
 
 
 
Section IV: Physical Properties
 
 
 
 
m.p./b.p.:
 
 
Purity:
 
 
 
 
 
 
Section V: Please list the Solvent/Solubility
 
 
 
 
Solvent:
 
 
Solubility:
 
 
 
 
 
 
Section VI: Please list Condition and Stablility
 
 
 
 
Condition: (Light, Moisture, Acetic Acid, etc.)
 
 
Stability: (Stable/Unstable)
 
 
 
 
 
 
Section VII: Please state the objective of the requested analysis
 
 
 
Better Resolution
 
 
Different Selectivity
 
 
Lower Cost
 
 
Alternative Detection
 
 
Higher Throughput
 
 
Other
 
 
 
 
 
Section VIII: Additional Information
 
 
 
 
Please provide any additional information that could be useful.
 
 
 
 
 
 
Throughout the year, JASCO participates in and offers several training courses and seminars. Occasionally, sample data from customer samples are useful as instructional examples for sample handling or data interpretation problems. Sample or company information is never provided with these educational spectra, but the spectra are used as demonstration and illustrative examples.
 
 
 
Do you wish to exclude your sample analysis results from this educational database?
 
 
 
Yes
 
 
No
 
 
 
Sample Approved for Analysis by:
 
 
 
 
SA#
 
 
Date:
 
 
 
Please mail samples to:
 
 
 
 
 
JASCO
 
 
Attn: Applications Department
 
 
28600 Mary's Court
 
 
Easton, MD 21601