Sample Submission Request

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When completing the sample submission form, please make sure that you use the same email address to which the link was sent.

Sample Submission Form

"*" indicates required fields

Country

Company Name*

First Name*

Last Name*

Email*

Phone Number*

Street Address*

City*

State*

Sample Type*

Number of Samples*

Please enter a number from 0 to 20.

Can we use the results in an application note*

Yes

Description of Sample/ Additional Information

What is the the objective of this analysis?

Stability & Storage Conditions

Please leave blank, if no special conditions are required.

Special Handling Requirements

Sample Concentration(s)

Sample Weight

Sample Impurity(%)

% Target in Matrix

Molecular Weight

m.p./b.p.

Solvent

Solubility

Spectroscopy Measurement Conditions

Experimental Conditions

Accessories Required

SFE Method Conditions

Current Extraction Technique

Method Details

e.g. (Solvent, pressure, temperature, extraction time)

Additional Information to assist with method development

Complete the following if HPLC analysis is required

HPLC/SFC Method Conditions

What is the objective of the requested separation?

Separation Column

Mobile Phase

Flow Rate

Injection Concentration

Injection Volume

Column Temperature (if required)

Detector Type and Wavelength(s) (if required)

Other Detector Parameters

Do not send your samples until you receive a case number.

Once you receive a confirmation email with the case number, please send your samples as below.

JASCO
Attn: Applications Department & Case Number
28600 Mary’s Court
Easton, MD 21601

If you do not receive a confirmation email within two hours please contact your local JASCO representative.

We respect your privacy. We never disclose data to any third-party without prior approval. If required, we will also enter into a non-disclosure agreement (NDA).