SHIPPING INFORMATION

BILLING INFORMATION

Name: ___________________________

Address: _________________________

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Phone: _______________

Fax: _________________

Name: ___________________________

Address: _________________________

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Phone: __________________

Fax: ____________________

P.O. #: __________________

Experiment(s) To Be Done: ES/MS _______ LC/ES/MS _______ NS/MS _______

Sample ID: ____________

Amount Supplied: _______ mgs _______ pmoles @ 100% by weight

Calculated Molecular Weight: ____________

Additional Information:

Isolated material? __________ Synthetic product: _______

Known salt present: Guanidine ______ SDS _______ acetate _______ TFA _______

Other salt additives: _________________________________

Biological hazard? _______ Radioactive? _______

Other Information/Requirements:

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