Sample Submission

Please complete the Sample Submission form as completely as possible, including the method of payment. Feel free to ship samples at your earliest convenience. An Impact Analytical representative will contact you to confirm their arrival and the project details.

Want to talk to someone directly? Please e-mail us at info@impactanalytical.com or call us directly at (989) 832-5555.

Client Information

* denotes requested field

Title*

First Name*

Last Name*

Company

Mailing Address*

Phone Number*

Extension

FAX Number

E-mail Address*

Send a copy of this quote request to my e-mail address

Sample Specifics

Date Quoted

Date Results are Needed

Sample Reference Number and Description*
[quantity, concentration, include chemical structures]

What is the Problem that you are trying to solve?*

Special Instructions
[safety precautions^†, sample matrix, desired detection limit, material compatibility, special analysis preparation needs, other material characteristics]

Are project results for submission to a federal agency?
Yes No

Would you like to be contacted to discuss project details?
Yes No

All hazardous samples will be returned to the customer. Return or discard non-hazardous samples?
Return Discard

Payment Options (one form needed before processing can begin)

PO Number

Fax hard copy to 989-832-5560

Remittance Address

OR

I will contact Impact Analytical (phone or fax) with payment information. Credit cards are accepted.

^†Impact Analytical reserves the right to refuse or to postpone analysis if safety information, including the MSDS, is not provided with the sample(s).