Mass Spectrometry Request	________________

Contact Information

Name:	_____________________________	Group:	_____________________________

Email:	_____________________________	Institution:	_____________________________

Phone:	_____________________________

Requested Methods

Ionization1:	Analysis type:
☐ ESI (± 5 ppm)	☐ FD (± 0.1 Da)	☐ reaction control
☐ APCI (± 5 ppm)	☐ MALDI	☐ compound characterization
☐ APPI (± 5 ppm)

Sample Information:

sample ID: ________________ sum formula: ________________ weighed mass (mg) or conc. (mmol/L): ________________ soluble in ☐ H2O ☐ CHCl3 ☐ CH3CN ☐ CH2Cl2 ☐ CH3OH ☐ DMSO (CHCl3, CH2Cl2, DMSO are FD only) if not applicable, other: ________________	Molecular structure Click on this field but not the central symbol to paste from clipboard!
sample purification: ☐ column chrom. ☐ HPLC ☐ distillation ☐ crystallization ☐ none TFA involved at any preparation step? ☐ yes ☐ no sample return requested: ☐ yes ☐ no	[M] ________________ [M]•+ ________________ [M+H]+ ________________ [M+Na]+ ________________ [M-H]- ________________

Comments and remarks:

Please hand in dangerous or instable samples personally!

______________	_________________________

Date	Signature