Name:___________________________________________________ Date:_____________
Tel:_______________________Email:____________________________
Advisor:___________________________
Account Number_______________________
Chemistry Mailbox Number_________________
Service Level:____________(full, data only).
Original sample ref. number:___________________________________
Chemical formula: (required)
Chemical Name:
Density (if known):___________ (g/cm3)
Is the sample Chiral?_________ Racemic?__________ air sensitive?__________
water sensitive?_______ light sensitive?_________ or temperature sensitive?____________.
What solvent(s) was the sample crystallized from?______________________
What information do you hope to get?
Draw structure (label all Chiral centers)