National Scientific Catalog and Samples Request Form

Thank you for interest in National Scientific products. To request copies of our catalogs or product samples, please complete the form below.

	Send me a copy of the National Scientific Chromatography Accessories Catalog

	Also, send me a copy of the Thermo Scientific Chromatography Columns and Consumables Catalog

	Please have a representative contact me to discuss my chromatography needs

Please send me samples of the following products:

Item #	Product Description	Qty.

* First Name:

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Department:

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What is your department's primary work function?

What is your current job role?

To ensure that you receive only items of interest to you, please take a few moments to answer the following questions.

Which of the following markets/applications apply to your work?
	Clinical Quantitation
	Drug Discovery
	Enviromental Testing
	Forensics
	Pharmaceutical Process / Discovery
	Other

Which of the following techniques do you currently use?
	GC
	LC
	GC-MS
	LC-MS
	Solid Phase Extraction