Boston College
Mass Spectrometry Facility Merkert Chemistry Center
Marek Domin Phone: (617) 552-3077
Lab: 101 Office: 101a Email:

External Users Mass Spectrometry Request Form
Please complete all parts of this form correctly before submitting.
Sample Name:
PO Number:
Billing Address:
Please indicate technique (if known):   ESI AP-MALDI DART ASAP
LC/MS (Provide gradient, wavelength and column)
Ionization Mode:   + vc - vc
Required Mass Accuracy:   Low Res High Res *
* high resolution will ONLY be run on examples first run Low Resulation
Proposed molecular formula:
Proposed molecular weight:
Proposed structure (or reaction scheme):
If sample is supplied in solution indicate: 
Concentraion:    Solvent:   
(Important: Avoid particulate matter in the sample; filter if necessary.)
If sample is a dry material, indicate: 
Amount submitted:    Soluble in:   
For all samples, list all other components (e.g. salts, buffers) and their concentrations:
Important: If the sample contains NR4+ (e.g. NBu4+), PPh4-, PPh3, P(O)Ph3, DMSO or TFA, please indicate:
Stability issues (e.g. temperature, acid):   
Toxicity issues:   
Storage:    RT 4°C -20°C dark
Check box if you want the sample returned to you after analysis: