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Sample
Submission Form
REPORT TO:
INVOICE TO:
Contact Name
AP Contact Name
Company
Quote #
Address
Address
City
City
State/Province
Same Address
PO #
State/Province
Zip/Postal Code
Zip/Postal Code
Country
Country
Phone Number
Phone Number
Fax
E-mail
Fax Number
REPORT SUBMISSION (check appropriate box)
TURNAROUND TIME (business days)
Fax
Courier*
Mail
Email
*Courier name and account No.:
SAMPLE DISPOSAL (check appropriate box)
Return Sample(s)*
Discard Sample(s)
*Courier name and account No.:
A $7 sample disposal/handling fee will be applied
Normal 10 Days
Rush 5 Days (Trace Metals 7 days)
50% Surcharge
Rush 2 Days
100% Surcharge
Rush 24 Hours
200% Surcharge
Date Results Required
STORAGE CONDITIONS (check appropriate box)
Room Temperature
Refrigerate (2°C to 8°C)
Protect From Light
Refrigerate (-10°C to -25°C)
Comments, special instructions and precautions (method, dispersing liquid, degassing temperature, etc. as applicable):
SAMPLE ID
SAMPLE DESCRIPTION / NAME
Submitted by:
ANALYSIS REQUIRED (Include test method, revision)
Date:
Priority, Rush, or Hazardous Material analyses require prior approval from Exova before sample submission.
Current Materials Safety Data Sheets (MSDS) must be sent with samples.
Services Provided are Governed by Exova Standard Terms and Conditions
To ensure compliance with GMP requirements, non-compendial test methods must be transferred and/or validated. Method transfer and/or validation services are available on request and are the responsibility of the client. Where
method transfer and/or validation have not occurred reports will indicate "method not validated for this matrix at this facility.
Exova Contact:
Submit Request by Email
Print Form
2395 Speakman Drive, Mississauga, Ontario L5K 1B3, CANADA Telephone: (905) 822-4111 Fax: (905) 823-1446