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ANALYSIS REQUEST FORM

Name of User / Research Student:

Name of Research Guide:

Name of Department:

Name of College / University / Company

Address:

Your Ref. No.

Email :

Phone:

Fax:

Date:

February 2012

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Mon

Tue

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Sat

I / We request you to analyse the samples as per details given below.

Sr. No.

Analysis required or Name of Instruments

Samples Identification and Details of samples *

No. of Samples

(*Note: In order to expedite your analytical work, please provide the information about any specific sample preparation method required, chemicals to be used, range of instruments to be used, any literature or your past analytical experience . We will appreciate your cooperation in this matter.)

Purpose of this analytical Work :

Title of Research Work / Project :

We agree to give you charges for our analytical work. Please send us a bill for the same in the name of: