Submit By *: Email *: Date *: Organization *: Tel *: Fax: Address *: PO# : Sample ID MW or Mwavg Molecular Formula (optional) Sample Files: Sample Toxicity Level: Highly ToxicityToxicitySafe Sample Quantity: For Solid (>50ug): mg Suitable Solvent: H2OMeOHCHCL3AcetoneDMSO For Liquid (>50ul at conc.~100ug/ml or higher): concentration: mg/ml Volume:mlDissolved in: Possible Cation(K+,Na+,etc.): Analysis Request:ElectrosprayLCMSMAIDI-TOF Scan Mode Required: PositiveNegativeBoth Other Request(optional) Control ID : File Name : Solvent Used :Print and SIGN the generated PDF and ship with your samples. Δ