Surface Area Sample Submission Form Microtrac Particle Analysis Laboratory 12501 62nd Street North, Largo, FL 33773 Please complete this form and include with sample and MSDS. Payment method must be included. Provide hard copy if using PO. PAYMENT INFORMATION AND PURCHASING CONTACT PRIMARY CUSTOMER CONTACT INFORMATION Not Required if Samples are for Instrument Purchase Evaluation Company Company Contact Name Contact Name Shipping Address Mailing or Billing Address City, State, ZIP City, State, ZIP Phone Number Email Address Email Address Phone Number FAX Number PO# or Credit Card and Type (AMEX, etc) Credit Card Expiration Date Signature Sales Rep: Samples submitted for evaluation of instrument purchase: Up to three samples no charge. Security Code Sales Rep Company: Type of Service Sample Return Information Charge 10 Business Day $50 minimum charge if no Shipping Account Number provided for Return Please Return Sample List Price Hold Sample 90 Days List + 30% 3 – 5 Business Day 24 Hour Not Available Same Day Not Available Discard Sample Shipping Account Number and Carrier If shipping account number is not available, charges will be assessed to cover additional costs of handling and shipping. On next page- Please add any comments (SOP#, special preparation, etc.) for the Microtrac analyst. Enter Your Sample ID Base Material Type Analysis Code from Price List Melting Point o ( C) Upper Limit of temperature to avoid change in particle structure o ( C) Expected Size of Pores if porosity desired. Expected Specific Surface Area 2 M /gm (Carbon, Silica,etc) Please use another sheet if more than 5 samples are being submitted Microtrac Will Enter Lab Tracking # in Blue Box Below Amount of Material – Typically 10 grams for most materials to provide for extra experiments if needed. Microtrac will complete the following Date Rec’d File Number Lab ID Log‐in by: Contacts: Toni Weigel, Phone 727-507-9770 Ext 14 ( [email protected] ) or Amelia Cullen Ext 20 ( [email protected] ). SF‐LA‐SA Rev B August 2013 Surface Area Sample Submission Form Microtrac Particle Analysis Laboratory 12501 62nd Street North, Largo, FL 33773 Please add any comments below (SOP#, special preparation, etc.) for the Microtrac analyst. Enter Your Sample ID Base Material Type Analysis Code from Price List Upper Limit of Temperature to Avoid that can change particle o structure ( C) Melting Point o ( C) Expected Size of Pores if porosity desired. Expected Specific Surface Area 2 M /gm (Carbon, Silica,etc) Please use another sheet if more than 5 samples are being submitted Microtrac Will Enter Lab Tracking # in Blue Box Below Customer Comments: ___________________________________________________________________________________________ ______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ _______________________________________________________________________________________________________________ ____________________________________________________________________________________________________ SF‐LA‐SA Rev B August 2013
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