Sample Analysis Form

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Ship to: Julie Y. Chen | HORIBA Instruments | 9755 Research Drive | Irvine, California 92618

Required with Submission: Safety Data Sheet (SDS), payment info and completed order form

All invoices and final PDF results print-out will be sent via email. Email info@jcanalysis.com for any questions.

Email *

Name of Organization *

Are you a new or existing customer?
*

New

Existing

Required

Address

Contact Name *

Phone Number *

Payment Method

We currently accept ACH (preferred), Credit Card and Global & Wire Transfers for those outside of the United States.

When using a credit card, an invoice will be sent directly from PayPal for secure processing using email indicated on the first page.

Preferred Payment Type
*

ACH Direct Deposit

Credit Card

Global & Wire Transfers

Other:

Required

Sample Information

Please complete this section to the best of your knowledge. These information will be used to ensure the integrity of your samples. We may contact you for clarification.

Sample(s) material? Please list all below.
*

Application? *

What do you want to learn about your samples? (e.g. size, concentration, zeta potential)
*

What is your existing measurement technique?

Nanoparticle Tracking Analysis

Laser Diffraction

Dynamic Light Scattering

Imaging Analysis

Sieving

None

I need to data correlation

I do NOT need data correlation

How should we handle your sample(s) at receiving?
*

Controlled room temperature (20 to 24°C)

Refrigerator (2-8°C)

Freezer (-10 to -25°C)

Light sensitive

Time sensitive

Any other stability concerns? Please note below in the next section:

Required

Note

Do you want your sample(s) back?

Yes (please include instruction and account info)

Limit of Liability

Test results are not necessarily representative of the sample characteristics extracted from the same or different lots. JCAnalysis assumes no responsibility, under any circumstances, for any commercial dispute or lost of profit. Reports are generated based on ISO 13320 for Laser Diffraction, ISO 22412 for Dynamic Light Scattering, and ISO 19430 for Particle Tracking Analysis recommendations. When additional service is requested outside of the mutually agreed proposal, a fee may apply.

A copy of your responses will be emailed to the address you provided.

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