NMRFAM service time request
NATIONAL MAGNETIC RESONANCE FACILITY AT MADISON
Biochemistry Building
University of Wisconsin-Madison

REQUEST FORM FOR SERVICE SPECTROSCOPY

Turn in this sheet when sample is brought into the NMR Facility.

Service times: Tuesdays 1 pm to 5 pm, Thursdays 1 pm to 5 pm (subject to change without notice)

[Please print or type]                                                                                                  Date: _______________

Name of person submitting sample:_________________________________________________________
Address:_________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
__________________________________________________________ Phone: (____)-____-_______

Principal Investigator: _____________________________________________________________________
P.I.'s Address:_____________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
__________________________________________________________ Phone: (____)-____-_________

Billing information (allocate % if more than one Grant):

______% Grant Title:___________________________________________________________________
_____________________________________________________________________________
Agency:______________________________________________________________________
Agency Grant Number:________________________________________________________

______% Grant Title:___________________________________________________________________
_____________________________________________________________________________
Agency:______________________________________________________________________
Agency Grant Number:________________________________________________________

______% Grant Title:___________________________________________________________________
______________________________________________________________________________
Agency:______________________________________________________________________
Agency Grant Number:________________________________________________________

Signature of Principal Investigator______________________________________
Signature of the Principal Investigator is Required in order to process the
sample(s). (not needed if signature is already on file at NMRFAM for this
project)

******************************

Samples are to be submitted ready to go, in approved 5 mm NMR tubes.
Sample volume should be 0.60 ml for a 5 mm tube. Volumes different
than this require more time (and therefore money) to shim adequately.

Sample description:

Nucleus: 1H 13C 31P 19F
Decoupling: yes no
Concentration:
Solvent:
Molecular Weight:
Internal Standard:
Stability:
Paramagnetics:

Plotting conditions:
Integrations: yes no
Expansions: yes no
Regions:
Peak picking: yes no

Data storage? yes no (If operator requires long-term data storage, they must provide
appropriate medium for this at the time the sample is turned in)

Special experiment?* yes no What?

Temperature:

Special requirements (perfusion, low temperature (< -20 oC), etc.):

Sample hazards?**
Radioactive? yes no If yes, counts , radioisotope
Biohazard (toxicity or other danger)? yes no
Explosive, unstable, high pressure, etc.? yes no

If yes to any of these questions, contact the facility manager for clearance.

* TOCSY, NOESY, ROESY, HMQC, HSQC, HMBC, DEPT90, DEPT135, Difference NOE,
and unlisted nuclei require operator assistance for hardware changes and first time setup.

** We reserve the right to make final judgment on the acceptability of any sample. Safety
precautions for containing the sample may be required.

User Charges: See current NMRFAM policy sheet.

Parking permits: Parking permits are available for outside users. Make arrangements in advance
with Parking and Transportation, Visitor Parking, 124 WARF Building, Madison, WI 53705
(608)263-8683.

Acknowledgments: Please acknowledge the facility in all publications containing data collected
or analyzed at NMRFAM. Recommended acknowledgement to be used in publications involving work
carried out at NMRFAM:

"This study made use of the National Magnetic Resonance Facility at Madison, which is supported
by NIH grant RR02301 from the Biomedical Research Technology Program, National Center for Research
Resources. Equipment in the facility was purchased with funds from the University of Wisconsin,
the NFS Biological Instrumentation Program (grant DMB-8415048), NIH Biomedical Research Technology
Program (grant RR02301), NIH Shared Instrumentation Program (grant RR02781), and the U.S.
Department of Agriculture.".