Home / NMR Spectroscopy Services / Forms / GxP NMR Sample Submission Form GxP NMR Sample Submission Form For use with GLP and GMP sample submissions only.CLICK HERE to access the form for samples not subject to GMP or GLP regulation. Step 1: Fill out the form below. Step 2: Click the SUBMIT button. Step 3: Check your email for a PDF of the completed form. Step 4: Print the PDF form and enclose it with your samples. Step 5: Mail us your samples. Date* Name* First Last Phone Number*FAX NumberEmail*A PDF will be emailed to you at this address that must be included with your sample submission. Company*PO#ShippingData will be returned via US Mail. If other shipment is preferred, please indicate here.GLP or GMP?*GLPGMPYou have chosen GLP; please indicate*FDAEPAIn-Process inspection required?*(additional costs applicable)YesNoProtocol/Method ID & Rev. #:*(if none, enter "None")To receive copies of NMR data via email, indicate:(you must have NMR processing software such as NUTS) FIDs spectra Sample ID*Solvent*(Note: This is the identifier that will be used in reports and on spectra)Sample Storage*Room tempRefrig (approx 5°C)Freezer (-10 to -20°C)Dry iceWork to be done*(Select all that apply) 1H 31P 13C 19F D2O exch Other You selected Other*Please enter additional requirements here.Sample to be*(Additional S&H charges are applicable)ReturnedDiscardedIndicate Hazards absorption inhalation smelly reactive special handling Notes:Would you like to submit a second sample now?YesNoSample ID*Solvent*(Note: This is the identifier that will be used in reports and on spectra)Sample Storage*Room tempRefrig (approx 5°C)Freezer (-10 to -20°C)Dry iceWork to be done*(Select all that apply) 1H 31P 13C 19F D2O exch Other You selected Other*Please enter additional requirements here.Sample to be*(Additional S&H charges are applicable)ReturnedDiscardedIndicate Hazards absorption inhalation smelly reactive special handling Notes:Would you like to submit a third sample now?YesNoSample ID*Solvent*(Note: This is the identifier that will be used in reports and on spectra)Sample Storage*Room tempRefrig (approx 5°C)Freezer (-10 to -20°C)Dry iceWork to be done*(Select all that apply) 1H 31P 13C 19F D2O exch Other You selected Other*Please enter additional requirements here.Sample to be*(Additional S&H charges are applicable)ReturnedDiscardedIndicate Hazards absorption inhalation smelly reactive special handling Notes:Would you like to submit a fourth sample now?YesNoSample ID*Solvent*(Note: This is the identifier that will be used in reports and on spectra)Sample Storage*Room tempRefrig (approx 5°C)Freezer (-10 to -20°C)Dry iceWork to be done*(Select all that apply) 1H 31P 13C 19F D2O exch Other You selected Other*Please enter additional requirements here.Sample to be*(Additional S&H charges are applicable)ReturnedDiscardedIndicate Hazards absorption inhalation smelly reactive special handling Notes:Would you like to submit a fifth sample now?YesNoSample ID*Solvent*(Note: This is the identifier that will be used in reports and on spectra)Sample Storage*Room tempRefrig (approx 5°C)Freezer (-10 to -20°C)Dry iceWork to be done*(Select all that apply) 1H 31P 13C 19F D2O exch Other You selected Other*Please enter additional requirements here.Sample to be*(Additional S&H charges are applicable)ReturnedDiscardedIndicate Hazards absorption inhalation smelly reactive special handling Notes:Would you like to submit a sixth sample now?YesNoSample ID*Solvent*(Note: This is the identifier that will be used in reports and on spectra)Sample Storage*Room tempRefrig (approx 5°C)Freezer (-10 to -20°C)Dry iceWork to be done*(Select all that apply) 1H 31P 13C 19F D2O exch Other You selected Other*Please enter additional requirements here.Sample to be*(Additional S&H charges are applicable)ReturnedDiscardedIndicate Hazards absorption inhalation smelly reactive special handling Notes:Would you like to submit a seventh sample now?YesNoSample ID*Solvent*(Note: This is the identifier that will be used in reports and on spectra)Sample Storage*Room tempRefrig (approx 5°C)Freezer (-10 to -20°C)Dry iceWork to be done*(Select all that apply) 1H 31P 13C 19F D2O exch Other You selected Other*Please enter additional requirements here.Sample to be*(Additional S&H charges are applicable)ReturnedDiscardedIndicate Hazards absorption inhalation smelly reactive special handling Notes:Would you like to submit a eighth sample now?YesNoSample ID*Solvent*(Note: This is the identifier that will be used in reports and on spectra)Sample Storage*Room tempRefrig (approx 5°C)Freezer (-10 to -20°C)Dry iceWork to be done*(Select all that apply) 1H 31P 13C 19F D2O exch Other You selected Other*Please enter additional requirements here.Sample to be*(Additional S&H charges are applicable)ReturnedDiscardedIndicate Hazards absorption inhalation smelly reactive special handling Notes:Legal Disclaimer* I have read and agree to be bound by the Privacy Policy of this website. 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