WHOI-MAT253


First Time Users Form

In order to run samples at the WHOI Micropaleontology Mass Spec Facility, you must first set up an account. Please complete all of the fields below before submitting your samples.

*required fields


First Name*

Middle Initial

Last Name*

Email*

Phone

Ext

Company/Affiliation

Street1

Street2

City

State

Country

Zip

Billing information

Billing Contact

Phone

Ext

Street1

Street2

City

State

Country

Zip
Please check off and complete appropriate billing information: (*required)
External Client - Federal Funds
(NSF, NASA, DOE, etc.) [Fees: Grants 0%; Contracts 5%] *
Agency Grant Number:
Purchase Order Number:
Credit Card Number**: Exp. Date:
External Client - Non-Federal Funds [Fee: 15%]*
Purchase Order Number:
Credit Card Number**: Exp. Date:
Internal Client - Federal and Non-Federal Funds [Fee: None]*
WHOI Project Number:
Foreign Client [Fee: 15%]*
Contract Number:
Purchase Order: (*required)
Issue a blanket PO, good for all anticipated calendar year analyses
         $ (amount of PO)
Issue a PO for a specific number of samples
         (number of samples)

Sample data needed by: (*required)
       I need this invoice by: (*required)

Approximate number of samples to be submitted this calendar year:
(*required)


Comments:


Work cannot commence until a purchase order is received.

A Purchase Order will be generated in the next window. Please print that page and send it to your accounting department.