Chemistry Services Request for Pricing

Please complete the following form to request a Silliker Chemistry Service Proposal.

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* Company:
* Subsidiary of:
* First Name:
* Last Name:
* Title:
* Address:
Suite:
* City:
* State/Province:	* Zip/Postal Code:
* Country:
* Telephone:	Fax:
* E-mail Address:
Other locations also working with Silliker:
Sample Matrix: (meat, cheese, etc.)
Tests Needed (please note individual test volumes in text boxes):
	Nutritional Labeling   Amino Acid Analyses   Cholesterol   Fat by Fatty Acid     Industry Nutritional Labeling Testing Packages: Baked Goods   Dairy   Meat and Poultry   Vegetable   Hard Candy-Beverage   Serving Size   Vitamin Assays    (please itemize volume of each vitamin) Fats and Oils   Proximates   Sugars   GI (Glycemic Index)   Physical   Extraneous Matter   Heavy Metal   Allergens    (please indicate volume of each allergen) Mycotoxins   Others  (please indicated tests and volumes below)
	Any Special Requirements? -- Select --YesNo If yes, please explain:
	Any Special Preparation Needed? -- Select --YesNo If yes, please explain:
	Routine Compositing Scheme Used? -- Select --YesNo If yes, please explain:
	Specific Methodology Needed or Required? -- Select --YesNo
	Expected levels or required detection limit:
	Sample Procurement needs: -- Select --CourierFedExOther If other, please explain:
	Are you obtaining bids from other laboratories? -- Select --YesNoOther If other, please explain:
Requested Turn-Around Time: