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Name*Email* Company NameAddress* Street Address City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country How You HeardWhere Did You Hear About Us?WebReferralTrade ShowSalespersonEmailWebinarHow You Heard TextPhone*FaxSample InformationMatrix of SampleMatrix of SamplePowderLiquidSolidTabletPillCapsuleSoftgelOtherOther MatrixName of Material# of Samples To Be AnalyzedTurn Around TimeTurn Around Time5 BDTAT4 BDTAT3 BDTATOtherBDTAT = Business Day TurnaroundOther BDTAT*Analytical RequestCheck each box that appliesAnalytical Service Groups Heavy Metal Analysis Total Quant II Lead by Isotope Dilution Fat Soluble Vitamins Water Soluble Vitamins Heavy Metal Analysis: Includes Lead, Arsenic, Cadmium, Mercury Total Quant II: Includes A Qualitative/semi-quantitative Scan For 65 Elements That is Best Suited For Waters, Soils, Ultra-pure, And Unknown Samples Only. (all elements listed below in Individual Elements except Silicon) Lead by Isotope Dilution: Includes Lead Fat Soluble Vitamins: Includes Vitamin A (beta carotene OR retinol OR retinyl palmitate OR retinyl acetate); Vitamin D2 (ergocalciferol); Vitamin D3 (cholecalciferol); Vitamin K1 (phylloquinone); Vitamin K2 (Menaquinone-4 AND -7, MK-4 and MK-7); Vitamin E (dl-alpha tocopheryl acetate OR dl-alpha-tocopherol); Fat Soluble Vitamins Bundle Water Soluble Vitamins: Includes Vitamin B1 (thiamine mononitrate OR thiamine HCl); Vitamin B2 (riboflavin OR riboflavin-5-phosphate); Vitamin B3 (niacinamide OR niacin); Vitamin B5 (pantothenic acid OR calcium-d-pantothenate OR d-panthenol); Vitamin B6 (pyridoxine HCl OR P5P); Vitamin B9 (folate); Vitamin C (ascorbic acid); Vitamin B7 (biotin); Vitamin B12 (cyanocobalamin OR methylcobalamin); Water Soluble Vitamins BundleSpecial InstructionsIndividual Elements to be Analyzed Aluminum (Al) Antimony (Sb) Arsenic (As) Barium (Ba) Beryllium (Be) Bismuth (Bi) Boron (B) Cadmium (Cd) Calcium (Ca) Cerium (Ce) Cesium (Cs) Chromium (Cr) Cobalt (Co) Copper (Cu) Dysprosium (Dy) Erbium (Er) Europium (Eu) Gadolinium (Gd) Gallium (Ga) Germanium (Ge) Gold (Au) Hafnium (Hf) Holmium (Ho) Indium (In) Iridium (Ir) Iron (Fe) Lanthanum (La) Lead (Pb) Lithium (Li) Lutetium (Lu) Magnesium (Mg) Manganese (Mn) Mercury (Hg) Molybdenum (Mo) Neodymium (Nd) Nickel (Ni) Niobium (Nb) Osmium (Os) Phosphorus (P) Palladium (Pd) Platinum (Pt) Potassium (K) Praseodymium (Pr) Rhenium (Re) Rhodium (Rh) Rubidium (Rb) Ruthenium (Ru) Samarium (Sm) Scandium (Sc) Selenium (Se) Silver (Ag) Silicon (Si) [ICP-OES] Sodium (Na) Strontium (Sr) Sulfur (S) Tantalum (Ta) Tellurium (Te) Terbium (Tb) Thallium (Tl) Thorium (Th) Thulium (Tm) Tin (Sn) Titanium (Ti) Tungsten (W) Uranium (U) Vanadium (V) Ytterbium (Yb) Yttrium (Y) Zinc (Zn) Zirconium (Zr) Other Individual Vitamers to be Analyzed Vitamin A (beta carotene OR retinol OR retinyl palmitate OR retinyl acetate) Vitamin B1 (thiamine mononitrate OR thiamine HCl) Vitamin B2 (riboflavin OR riboflavin-5-phosphate) Vitamin B3 (niacinamide OR niacin); Vitamin B5 (pantothenic acid OR calcium-d-pantothenate OR d-panthenol) Vitamin B6 (pyridoxine HCl OR P5P) Vitamin B7 (biotin) Vitamin B9 (folate) Vitamin B12 (cyanocobalamin OR methylcobalamin) Vitamin C (ascorbic acid) Vitamin D2 (ergocalciferol) Vitamin D3 (cholecalciferol) Vitamin E (dl-alpha tocopheryl acetate OR dl-alpha-tocopherol) Vitamin K1 (phylloquinone) Vitamin K2 (Menaquinone-4 AND -7, MK-4 and MK-7) Fat Soluble Vitamins Bundle Water Soluble Vitamins Bundle Amino Acids to be Analyzed Acid Hydrolyzed Amino Acids (Aspartic Acid, Glutamic Acid, Alanine, Arginine, Glycine, Histidine, Isoleucine, Leucine, Lysine, Phenylalanine, Proline, Serine, Threonine, Tyrosine, Valine) Base Hydrolyzed Amino Acid (Tryptophan) Performic Acid Oxidized Amino Acid (Cystine and Methionine) Taurine N-Acetyl L-Tyrosine Other