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Analytical Service Request Form

Evans Analytical Group (NY)

Please complete the form below. You can also download and Fax the PDF version of this form and fax it to (315) 431-9800. If you have any questions, please contact Evans Analytical Group (NY) at (315) 431-9900 or email .

* Indicates Required Field  
 

Submitted by
First Name*:
Last Name*:
Company Name*:
Telephone*:
Fax*:
E-mail*:
     
 

Order Information

PO Number:  
Number of Samples *:
Material/Matrix*:
Rush Service? YES (Additional fees apply)  
Return Samples*? YES NO (Additional fees apply)
Report Delivery Method*: Fax Email Fax and Email
Job/Quote Number  
 

Analysis Information
 

GDMS

   
Select one: Bulk Analysis
Depth Profile
Select one: Full Scan
Single Scan (1 element - please specify below)
Partial Scan (up to 25 elements - please specify below)
 
Li Sc Se In Gd Ir
Be Ti Br Sn Tb Pt
B V Rb Sb Dy Au
F Cr Sr Te Ho Hg
Na Mn Y I Er Tl
Mg Fe Zr Cs Tm Pb
Al Co Nb Ba Yb Bi
Si Ni Mo La Lu Th
P Cu Ru Ce Hf U
S Zn Rh Pr Ta  
Cl Ga Pd Nd Re  
K Ge Ag Sm Os  
Ca As Cd Eu W  
     
 

IGA

    
Select all which apply: H
C
N
O
S
     
 

ICP

   
Select One: ICP/OES ICP/MS LA-ICP/MS
     
Select all which apply:  
Li Sc Se In Gd Ir
Be Ti Rb Sn Tb Pt
B V Sr Sb Dy Au
Na Cr Y Te Ho Hg
Mg Mn Zr Cs Er Tl
Al Fe Nb Ba Tm Pb
Si Co Mo La Yb Bi
P Ni Ru Ce Lu Th
S Cu Rh Pr Hf U
K Zn Pd Nd Ta  
Ca Ga Ag Sm Re  
  Ge Cd Eu Os  
  As     W  
 
 
In this space please provide any new contact information or other comments that will help us process your samples (purpose of analysis, sample identifications, lot numbers, expected contaminations, specs, etc.).