Centre of Excellence in Analytical Pyrolysis
Sample Analysis Request Form
For more info, visit website :
https://anpy.somaiya.edu/en
Customer's Information
Name
*
First Name
Last Name
Email ID
*
example@example.com
Contact No
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Please enter a valid phone number.
Format: 00000-00000.
Company Name
*
Division
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Country
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Distributor’s Information
Name
*
First Name
Last Name
Email ID
*
example@example.com
Contact No
*
Please enter a valid phone number.
Format: 00000-00000.
Company Name
*
Division
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Country
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Sample Information
[Attach supplement information if needed] Please provide more than 30mg for each sample.
Sample Name
*
Sample Picture
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Sample Form
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Powder
Sheet
Block
Paste
Pellet
Liquid
Solution, suspension
Other
Compound name and estimate concentration of samples ?
*
Polymers
*
Additives
*
Other Compounds
*
Please Select
Evolved Gas Analysis
Single Shot Analysis
Double Shot Analysis
Heart Cut Analysis
Purpose of Analysis
*
Background of Analysis
*
Issue of present analytical method [Provide data if available]
Due date of Report
*
Can lab use the data for publication [presentation, conference,brochure, papers, etc?]
Yes
No
Analytical system currently used ?
*
GC, GCMS Maker : Model : Pyrolyzer Maker : Model :
Do you want to return samples?
*
Yes
No
Return address [please fill in the return address only if you wish to return the sample]
Other
*
*
I acknowledge that providing accurate and complete information is essential for precise analysis
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