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 or call us directly at 855.IA SOLVE (427.6583)

Client Information

* denotes requested field

First Name*
Last Name*
Mailing Address*  
Phone Number*   
FAX Number
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?

Would you like to be contacted to discuss project details?

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


Payment Options (one form needed before processing can begin)
PO Number
Fax hard copy to 989-832-5560
Remittance Address  
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).

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