Mass Spectrometry Facility
Advanced Analysis Centre
Science Complex Rm. 1205
Tel. 519-824-4120 ext. 58649
Request for Small Molecule Chemical Formula Mass Spectrometry
Please check if you want the rest of your sample returned
Date Submitted: E-mail:
Submitted By: Phone Number:
Post-doc PhD MSc UnderG Tech Faculty Other
Supervisor: Department:
Sample Code:
Please use separate sheet or reverse if space is not
Number of Samples:
Expected Molecular
Molecular Formula:
Approximate Concentration:
Ionization Polarity:
Pos Neg
Sample Desalt or Concentration Required
(additional cost):
Yes No
If so Details:
For price information please visit
I approve
payment for this work within a 10% variance of estimated amount quoted at and I authorize the Mass Spectrometry Facility and
CBS Clerical Unit Staff to charge my
Trust Fund# _____________ - _____________ - _____________ - ______________ - ____64251____
Please provide full coding
Signature: ______________________________________________________________
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