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Sample Submission Form Please enable JavaScript in your browser to complete this form. – Step 1 of 3Customer InformationName: *Ledoux ID Number (Optional)Address: *Address Line 1Address Line 2CityState / Province / RegionPostal CodeEmail Address: *Phone Number: *NextSample Analysis DetailsType of Analysis Requested: *Please Select OneSingle-Party ControlPilotSemi QuantUmpireSecondary Party Contact Name: *Secondary Party Contact Email Address: *Secondary Party Contact Phone Number: *Secondary Party Address: *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryLot or Sample Number: *Material Description: *Please Select OneAutomotive Catalyst – 30-to-50 Grams NeededBullion – 15-to-20 Grams NeededElectronic Scrap – 50-to-70 Grams NeededEO Catalyst – 50 Grams NeededFilm Scrap – 30-to-50 GramsHigh-Grade Precious Metal Concentrates – 10-to-15 GramsHigh-Purity Metals – 2-to-3 Grams NeededKarat Gold – 3-to-4 Grams NeededKarat Gold / Silver Combination – 7-to-10 Grams NeededLow-Grade Ores – 100 Grams NeededPrecious Metal Sweeps – 25-to-30 Grams NeededReforming Catalyst Powder – 30-to-50 Grams NeededReforming Catalyst Pellets – 75-to-100 Grams NeededSlurries – 200-to-300 ml NeededMaterial Container Type: *Please Select OneBagBag (Foil)BottleBottle (Large)Bottle (Small)Bottle (Plastic)CanEnvelopeEnvelope (Foil)Envelope (Plastic)JarTubeVialAnalyze for the Following Elements: *Report Basis: *Please Select OneAs ReceivedDryIgnitedDoes Sample Need to Be Ignited? *NoYesIgnition Temperature Should Be? *Please Select OneN/A105 C110 C120 C900 C1000 CIgnition Time Should Be? *Please Select OneN/AO/N6 Hours4 Hours2 Hours1 HourDoes Sample Need to Be Dried? *NoYesDrying Temperature Should Be? *Please Select OneN/A105 C110 C120 C900 C1000 CDrying Time Should Be? *Please Select OneN/AO/N6 Hours4 Hours2 Hours1 HourReporting Unit *Please Select OneGrams Per LiterGrams Per Metric TonOunces Per TonParts Per MillionParts Per ThousandPercentageTroy Ounce Per GallonTroy Ounce Per TonNextPayment DetailsPurchase Order Number (if applicable):Sample Analysis Will Be Paid by: *Please Select OneInvoice Me (approved customers only)Bank Wire / TransferThird-Party BillingAfter Completed Analysis, Samples Are to Be: *Please Select OneReturned to Customer (additional shipping and handling fee)DisposedEmail Analysis Results to: *How Did You Hear about Us? *Please Select OneEmail from UsInternet SearchReferralTradeshowWorked with Us PreviouslyIf 'referrel' can you please provide the person or company who referred you? 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