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Surface Area Sample Submission Form
Microtrac Particle Analysis Laboratory
12501 62nd Street North, Largo, FL 33773
Please complete this form and include with sample and MSDS. Payment method must be included. Provide hard copy if using PO. PAYMENT INFORMATION AND PURCHASING CONTACT
PRIMARY CUSTOMER CONTACT INFORMATION Not Required if Samples are for Instrument Purchase Evaluation Company
Company
Contact Name
Contact Name
Shipping
Address
Mailing or Billing Address
City, State, ZIP
City, State, ZIP
Phone Number
Email Address
Email Address
Phone Number
FAX Number
PO# or Credit Card and
Type (AMEX, etc)
Credit Card Expiration Date Signature Sales Rep: Samples submitted for evaluation of instrument purchase: Up to three samples no charge. Security Code Sales Rep Company: Type of Service
Sample Return Information Charge
10 Business Day
$50 minimum charge if no Shipping Account Number provided for Return Please Return Sample
List Price
Hold Sample 90 Days
List + 30%
3 – 5 Business Day
24 Hour
Not Available
Same Day
Not Available
Discard Sample
Shipping Account Number and
Carrier
If shipping account number is not available, charges will be assessed to cover
additional costs of handling and shipping.
On next page- Please add any comments (SOP#, special preparation, etc.) for the Microtrac analyst.
Enter Your Sample
ID
Base Material Type
Analysis
Code from
Price
List
Melting
Point
o
( C)
Upper Limit of
temperature to
avoid change in
particle structure
o
( C)
Expected
Size of
Pores if
porosity
desired.
Expected
Specific
Surface Area
2
M /gm
(Carbon, Silica,etc)
Please use another sheet if
more than 5 samples are being
submitted
Microtrac Will Enter Lab
Tracking # in
Blue Box Below
Amount of Material – Typically 10 grams for most materials to provide for extra experiments if needed.
Microtrac will complete the following Date Rec’d File Number Lab ID Log‐in by: Contacts: Toni Weigel, Phone 727-507-9770 Ext 14 ( Toni.Weigel@MIcrotrac.com ) or Amelia Cullen Ext 20 ( Amelia.Cullen@Microtrac.com ).
SF‐LA‐SA Rev B August 2013 Surface Area Sample Submission Form
Microtrac Particle Analysis Laboratory
12501 62nd Street North, Largo, FL 33773
Please add any comments below (SOP#, special preparation, etc.) for the Microtrac analyst.
Enter Your Sample
ID
Base Material Type
Analysis
Code from
Price
List
Upper Limit of
Temperature to
Avoid that can
change particle
o
structure ( C)
Melting
Point
o
( C)
Expected
Size of
Pores if
porosity
desired.
Expected
Specific
Surface Area
2
M /gm
(Carbon, Silica,etc)
Please use another sheet if
more than 5 samples are being
submitted
Microtrac Will Enter Lab
Tracking # in
Blue Box Below
Customer Comments: ___________________________________________________________________________________________
______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________
_______________________________________________________________________________________________________________ ____________________________________________________________________________________________________ SF‐LA‐SA Rev B August 2013