Acorn NMR Inc.
NMR Sample Submission Form
Do not use this form for GLP/GMP samples

Print this form and enclose with your samples.  Please read our shipping guidelines  

Date ________________ 

Name ______________________   Phone _____________  email_____________________

Company ___________________   FAX  _______________     PO#  ______________

Data will be sent via email as pdf (Adobe Acrobat reader required)

To receive NMR data files instead, indicate:   FIDs     spectra

(you must have NMR processing software such as NUTS)

Sample ID ____________________         Solvent __________________    

 (Note:  This is the identifier that will be used in reports and on spectra)

Work to be done (Circle all that apply)   1H   31P   13C   19F  D2O exch   Other ______ 

Sample to be (Circle one):       Returned     Discarded  

Indicate Hazards:  absorption  inhalation   smelly    reactive   special handling

Special requests: 

Sample ID ____________________            Solvent __________________    

 (Note:  This is the identifier that will be used in reports and on spectra)

Work to be done (Circle all that apply)   1H   31P   13C   19F  D2O exch   Other ______ 

Sample to be (Circle one):       Returned     Discarded  

Indicate Hazards:  absorption  inhalation   smelly    reactive   special handling

Special requests: 

Sample ID ____________________              Solvent __________________    

 (Note:  This is the identifier that will be used in reports and on spectra)

Work to be done (Circle all that apply)   1H   31P   13C   19F  D2O exch   Other ______ 

Sample to be (Circle one):       Returned     Discarded  

Indicate Hazards:  absorption  inhalation   smelly    reactive   special handling

Special requests: 

Acorn NMR Inc.                 (925) 456-1020

7670 Las Positas Rd.           (925) 456-1024 FAX

Livermore, CA   94551                                                6/12/07