Chemtos, LLC

Compound Recertification Submission Form

Our compound recertification service includes a comprehensive Certificate of Analysis and all supporting documentation prepared under GLP conditions. Standard certification includes HPLC Purity Analysis, Mass Spectrometry Analysis, and NMR Analysis.

Minimum 5 mg of compound required unless prior arrangements have been made.

Please complete this form, print the confirmation page and include with your sample.



Name (*)

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Company (*)

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Email (*)

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Phone (*)

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Fax

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Purchase Order #

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Date Needed

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Sample ID(s) (*)

Required Field Multiple sample IDs can be included on the same submission as long as all the information below is the same.

Controlled Substance (*)

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If yes, DEA Registration Number

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Send Certificate of Analysis via (*)




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Service Level (*)



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NMR Solvent (*)

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Return NMR Sample (with solvent in sealed ampoule) (*)



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Add-on Services






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Hazardous (*)

Required Field No Radioactive and/or Bio-Hazardous Samples

Hazardous Properties







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SpecialHandling









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Comments

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Enter the Text Below

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Please print the confirmation page after submitting and include with your sample.

By accepting this analytical services request, I agree to Chemtos’ Terms & Conditions, unless otherwise agreed upon in writing.