Sample Submission Form Please enable JavaScript in your browser to complete this form. - Step 1 of 3Customer InformationName: *Address: *Address Line 1Address Line 2CitySelect StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip 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 2CitySelect StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeLot 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 TransferCredit CardThird-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 PreviouslyAdditional Information (if needed):Upload File (if necessary): Click or drag a file to this area to upload. Captcha * = EmailSend