Company*
Name*
Address*
City
State
ZIP
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E-mail address*
Budget available?		yes No
If yes how much?
Time frame for purchase		ImmediateWithin 3 monthsWithin 6 monthsWithin 1 yearI don't know
		Sample information  Sample information
Components to be analyzed
Sample type (CTRL click for multiple selection)		LiquidGasLPG
Sample pressure
Sample temperature
		Analyzer requirements  Analyzer requirements
Standard method (ASTM, ISO, Etc...)
Prefered injections (gas,liq, LPG, Headsapce)
Number of sample per day
		Autosampler required
		Stop flow valve required
		Back pressure requlator required
		Is method development requested?
Prefered column		Capillary columnPacked column
Will you supply a test sample?		Yes No
Do you already analyze this sample		Yes No
If yes please provide details of method, GC brand, Columns, etc...
Comments/remarks
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