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Custom solutions order request form

For a re-quote of an existing custom standard please provide
Part number or Quote number *
No ANALYTE CAS NUMBER (for compounds, if available) CONCENTRATION
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Asterix * denotes mandatory field.

Solvent*
Volume *
Container *, e.g.,CERTAN® capillary bottle*Ampoule 1.5mL Bottle with screw cap
Number of units *
We recommend that volatile / organic solutions are packed in CERTAN® capillary bottles.
Minimum expiry period ( 3 months, 6 months, other) *
Validation protocol, e.g., Gravimetric, Quantitative, ISO Guide 34 *
Please provide details of your analytical technique in order that we can as far as possible tailor uncertainty calculations *
Have you purchased from LGC Standards before? * YesNo
Contact Details
Organization Name*
Title *
First Name *
Last Name *
Telephone Number *
Email Address *
Re-type email address *
Invoice Details
Organization Name *
Company Number
Address Line 1 *
Address Line 2
Address Line 3
Address Line 4
City *
Country*
County*
State
Post Code*
Telephone number *
Shipping details
Tick if shipping same as Invoice Details
Organization Name *
Address Line 1 *
Address Line 2
Address Line 3
Address Line 4
City *
Country*
County*
State
Post Code*
Telephone number *
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