Sample Submission (From Quotation)

Please complete the following form for your sample submission. The form requires a quotation which can be requested on the Quick-E-Quote page. If you have any questions, don’t hesitate to contact us!

"*" indicates required fields

Company

This field is for validation purposes and should be left unchanged.

Quotation or reference report number*

Please enter the reference number on your quote "WO-#####". Don’t have a quotation? Request a quote here. If this request is consistent with work previously performed for you by H&M, you may enter the report reference number found in the file name of your previous report "Report-####-..." and a quote will be sent to you for confirmation of the cost for the same testing on this new material.

If this information is the same as what was provided in your referenced quote, you may just fill in the required fields and the remaining information from your quote request will be used.

Title (optional) and Full Name:*

Phone Number:

Company Name:

Report Recipient Email:*

Address:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

CC Report to the Following Email Addresses:

Billing

*You do not need to enter your full payment information at this time. A link to pay your invoice will be emailed within 5 business days of testing completion to the provided A/P email, or the report recipient. For credit card payments, your invoice will include a link to enter your information using a secure payment portal.

Payment Method:*

Check

Direct Transfer

Credit Card

PO Number:

A/P Email:

Billing Contact Name:

Sample Information and Test Selection

Sample information: Data entered here will be used, as it is entered, to identify the samples. Please verify the accuracy of the sample description entered. If your project consists of more than 12 samples, please contact us for a larger project form.

Sample #1 - Description*

Add More Samples?

Yes, add another sample

Sample #2 - Description

Add More Samples?

Yes, add another sample

Sample #3 - Description

Add More Samples?

Yes, add another sample

Sample #4 - Description

Add More Samples?

Yes, add another sample

Sample #5 - Description

Add More Samples?

Yes, add another sample

Sample #6 - Description

Add More Samples?

Yes, add another sample

Sample #7 - Description

Add More Samples?

Yes, add another sample

Sample #8 - Description

Add More Samples?

Yes, add another sample

Sample #9 - Description

Add More Samples?

Yes, add another sample

Sample #10 - Description

Add More Samples?

Yes, add another sample

Sample #11 - Description

Add More Samples?

Yes, add another sample

Sample #12 - Description

Test selection – choose from each dropdown, you may select up to 4 different tests, if different tests are to be run on different samples, please indicate using the check boxes which tests apply to which samples entered above, or click “All” to have all entered samples run for the selected test.

Select TEST #1:*

Please run TEST #1 on samples (select):*

Add another test?

Yes, add another test

Select TEST #2:

Please run TEST #2 on samples (select):

Add another test?

Yes, add another test

Select TEST #3:

Please run TEST #3 on samples (select):

Add another test?

Yes, add another test

Select TEST #4:

Please run TEST #4 on samples (select):

Return of Material (check if applicable)

Material needs to be returned after testing (return shipping fees apply)

Check any that may apply:

Material is wet and will need to be dried at higher than room temperature prior to use

Material contains hard fragments such as stones or carbides, that will require milling to produce a fine powder

Project requires additional preparation of samples such as standard mixing, or select removal of components (please specify requirements below)

Material is temperature sensitive (specify maximum storage and/or degradation temperature below)

Material is a bulk sample to be analyzed as-is (samples such as metal coupons, fabrics, etc. Please specify sample size below)

Material may contain hazardous components such as flammable substances, radioactive materials, volatile compounds, high health risk compounds, or reactive components (specify below)

Additional Information:

Rush Options

Rush reduced TAT (3-5 business days)

Rush ASAP (generally 1-2 business days - as soon as the results can be provided)

Report required by (Enter date below) - The appropriate charge will be added when the samples are received to ensure the result is delivered by the indicated date (if possible). By checking this box you are agreeing to all potential rush fees associated with processing the request.

Estimated turn around times are based on 1-2 tests for up to 12 samples, larger batches or multiple tests will increase this timeframe. Please contact us for availability if an approval/quote has not already been issued for the request.

Report Due Date

Please enter if a rush is requested.

Reporting

Please choose if you did not receive a quote for this specific request.

Terms and Conditions

Please read each document below for the terms and conditions for each test and verify you have read and agree to the information outlined in each document by checking the box next to each document link.

General Terms & Conditions*

I hereby confirm that I have read, understood and accept the General Terms and Conditions.

XRD Sample Submission Policies*

I hereby confirm that I have read, understood and accept the XRD Sample Submission Policies.

These policies apply to XRD – Qualitative, XRD – Quantitative, and XRD - Special Tests.

XRD Sample Submission Policies and XRD DACO Sample Submission Policies*

I hereby confirm that I have read, understood and accept the XRD Sample Submission Policies and XRD DACO Sample Submission Policies.

These policies apply to XRD – Data collection (DACO).

XRD with Amorph Sample Submission Policies*

I hereby confirm that I have read, understood and accept the XRD with Amorph Sample Submission Policies.

These policies apply to XRD Quantitative with amorphous spiking.

XRD Pharmaceutical Sample Submission Policies*

I hereby confirm that I have read, understood and accept the XRD Pharmaceutical Sample Submission Policies.

These policies apply to XRD – cGMP (both options).

XRF- Fused Bead Sample Submission Policies*

I hereby confirm that I have read, understood and accept the XRF- Fused Bead Sample Submission Policies.

These policies apply to XRF – Fused Bead.

Particle Size Distribution (PSD) Sample Submission Policies*

I hereby confirm that I have read, understood and accept the PSD - Sample Submission Policies.

These policies apply to Particle Size Distribution

XRF - Pressed Pellets Sample Submission Policies*

I hereby confirm that I have read, understood and accept the XRF - Pressed Pellets Sample Submission Policies.

These policies apply to XRF – Pressed Pellet.

SEM Sample Submission Policies*

I hereby confirm that I have read, understood and accept the SEM Sample Submission Policies.

These policies apply to all SEM and EDS options.

TGA Sample Submission Policies*

I hereby confirm that I have read, understood and accept the TGA Sample Submission Policies.

These policies apply to TGA – all options.

DSC Sample Submission Policies*

I hereby confirm that I have read, understood and accept the DSC Sample Submission Policies.

These policies apply to DSC – all options.

Both TGA and DSC Sample Submission Policies*

I hereby confirm that I have read, understood and accept the TGA Sample Submission Policiesand DSC Sample Submission Policies.

These policies apply to STA.

Select one:*

I certify that the material submitted meets the requirements outlined in the applicable testing document for the selected tests. I assume liability for any damages that may occur to equipment as a result of requests made on inappropriate materials, as defined in the reference documents listed above.

I cannot certify that the material submitted meets the requirements outlined in the applicable testing document for the selected tests. I agree to receive a quotation for additional testing costs that may be required to verify the safety of the substance for the requested testing prior to H&M conducting the requested analysis. I understand that if the substance is identified as a hazard for the test I selected, that I am responsible for the cost of the verification testing regardless of whether or not the test I originally requested can be performed.

By submitting this digital form I certify I have read all of the supplied documents as indicated above, and I understand my responsibility as the sample submitter. I accept all specified liabilities as outlined in the above documents and certify that I have provided all information regarding the known composition(s) and/or potential hazards associated with the submitted material to the best of my knowledge.

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