Analysis Request Form


         * required fields

Existing Customer (If all information is current, please fill out Section A only)

New Customer (Please fill out Sections A and B)


Section A (existing and new customers)

Prior SSW Contact

* Company/Division

* Person Requesting Analyses

* E-mail Address
        (separate multiple addresses with comma)

Your Purchase Order Number
Standing P.O. Other(Please communicate directly with SSW)

* Turnaround Requested
Normal
(Results generally within 14 business days of sample receipt)
72 Hour         50% Surcharge
(Minimum verbal report within three business days of sample receipt)
24 hour         100% Surcharge
(Minimum verbal report within one business day of sample receipt)

* Description of Samples/Service Required and/or Problem
Same as Previous Job(s) Ref. SSW job# if known
Will communicate with SSW staff to describe details
Or Describe Problem


Report Format
E-mail
Hard Copy
Fax
Compact Disk via Courier **
         **$10.00 CAD for Canadian shipments will be added to invoice
        **$50.00 USD for U.S./International shipments will be added to invoice

* Return Samples After Analysis
No Yes (shipping charges will be added to invoice)

(N.B. samples will be disposed of 60 days after analysis unless otherwise advised)

Materials Specific Regulatory Requirements (MSDS datasheet required for all applicable substances)

Radioactive
Bio-Hazardous
Toxic
Dangerous Goods
Description:



Section B (new customers)

Shipping Address (Street address required for courier)


Invoicing Address; Same as Shipping Address

Telephone Number Alternate Phone Number

Fax Number

Sample Submission Guidelines

  • Samples and area(s) of analysis should be clearly marked and labeled.
  • International shipments should be valued at $1.00 USD. Collect shipments will be accepted, however any customs/brokerage/courier charges will be billed back to the client.
  • IMPORTANT: A surcharge of $25.00 CAD/$15.00 USD will be levied when obvious dangerous/hazardous goods arrive in our facility without the appropriate Dangerous Goods Declaration and MSDS.





Form #ARF_01_02


Contact

.:Ross Davidson
Manager, Scientific Operations
Call: (519) 661-2173
Fax: (519) 661-3709
E-Mail us

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