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					                                                                                                               Submit by E-mail            Print Form
                   Analytical Services                            Quote Request

CUSTOMER INFORMATION ( * indicates required field)

Contact Name*:

Job Title:                                                                                                  Referred by*:
Company*:

Address*:




City:                                     State:                       ZIP code:

Business Type:

Telephone No.*:

E-mail*:

FAX No.:


SAMPLE(S) INFORMATION
Please complete the following questionnaire as thoroughly as possible to help us expedite delivery of a comprehensive quote.


Description of Problem or Need (optional)
Please describe what kind of information you want to obtain from your sample




Desired Test Methodology
If you already have decided on the type of analyses to be performed, please complete the following field




Physical and Chemical Characteristics
Please be thorough; this data will help us to serve you better.
                                                                                                                    Amount available (mg):

                 Toxic?                            Hygroscopic?                  Moisture Sensitive?                        Light Sensitive?

        Air Sensitive?                      Thermally Stable?                                   Pure?                          Aggregation?

                MSDS?                        Melting Point (C)                      Boiling Point (C)

 Molecular Formula:                                                 Chemical Name:

             Soluble in:
Additional information                                                             Structure (if known)
                                                                                   If you have partial information, please add it as well (JPG, GIF or TIFF only)




Number of samples with these characteristics
If you have several samples with other characteristics, please describe below or fill additional forms




How soon do you need your analytical results?


How soon do you need an estimate?

Today's date

OPTIONAL INFORMATION


Have you tried any other method/s besides the ones you are requesting to solve your problem?
Please describe




Have you received service from other providers regarding this problem?
If you answer is "yes", could you briefly share your results/problems with that experience?




Using this form means you understand our Privacy Statement and agree to our Terms and Conditions as described at the
Bruker Analytical Services web site. You can send this form electronically using the "Submit by E-mail" button; or you can print and FAX to
(281) 292-2474 (Attn. : BAS) or mail to:  BAS
                                           2700 North Crescent Ridge Drive
                                           The Woodlands, TX 77381
                                           USA

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Description: requesting a quote Quote Request