Prefix Mr. Ms. Mrs. Dr.

Name*

Organization*

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Address*

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State*

Zip*

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Phone*

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How did you learn about us? I'm an existing client. From a web search. From a conference/trade show. From a direct mailing. I was referred by someone. Other.

Current address of spectrometer(s)?*

Future address of spectrometer(s)?*

Spectrometer(s) to be reinstalled or stored?*

1st NMR Console manufacturer and model?*

1st NMR Magnet manufacturer, style, age and field strength?*

1st NMR spectrometer age and field strength?*

1st NMR spectrometer currently operational?*

2nd NMR Console manufacturer and model?*

2nd NMR Magnet manufacturer, style, age and field strength?*

2nd NMR spectrometer age and field strength?*

2nd NMR spectrometer currently operational?*

3rd NMR Console manufacturer and model?*

3rd NMR Magnet manufacturer, style, age and field strength?*

3rd NMR spectrometer age and field strength?*

3rd NMR spectrometer currently operational?*

Spectrometer(s) installation data retained?*

Prepare NMR system for shipment?*

Shipping crate(s) retained?*

Energization equipment retained?*

1st choice of relocation date:*

2nd choice of relocation date:*

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