Contact Information

    Name         

   Company   

   Address     

   City                   State           Zip Code   

   Phone         

   Fax              

   email           

Vial Information

   Your Current Vial Source   

   Part # of Current Vial         

   Your Current Price per Package    $ per package of 

   Quantity Used:     vials per  Week Month Year

   Autosampler or other instrumentation vial is used with Select Instrument Agilent A.I.M A.I. Alcott Alltech Altex AMS Antek ASC Beckman Bruker Carlo Erba/Fisons Carnegie ChromPack Dani Delsi Dynatech Finnigan GBC/Gerstel Gilson Gynkotek Hewlett-Packard Hitachi IBM ICI Infochroma Jasco Kipp Kontron LDC Leap Technologies Magnus Scientific Packard/Chrompack Pharmacia LKB Phillips/PYE Polymer-Labs S.G.E. Sedere Shimadzu Siemens Sigma Spark Holland Spectra-Physics Talbot Thermo Separations TOA TosoHaas Tosca 1 Tracor Unicam United Tech. Varian/Rainin Varian Waters   (model #)

   Vial Dimensions    6 x 32 7 x 30 7 x 40 8 x 30 8 x 40 12 x 32 15 x 45 Other    Please give dimension here if "Other" was selected

   Vial Volume    mL

   Vial Finish    8mm Crimp 11mm Crimp 13mm Crimp 20mm Crimp 8-425 Screw Thread 9mm Screw Thread Robotic 10-425 Screw Thread 13-425 Screw Thread 15-425 Screw 18-400 Screw 20-400 Screw 24-400 Screw 8 x 40 Shell 12 x 32 Shell 15 x 45 Shell 11mm Snap Ring 13mm Snap Ring Other   Please give finish here if "Other" was selected

   Vial Material  Type 1 borosilicate glass amber glass polypropylene PP polymethylpentene TPX polytetraflouroethylene PTFE Other   Please give material here if "Other" was selected

   Cap, Septa, Insert or other vial accessories used   

   (i.e. 8-425 cap with 0.065 PTFE/Sil septa and 100uL clear glass insert)

Other Relevant Information

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