National Magnetic Resonance Facility at Madison (NMRFAM)
          University of Wisconsin-Madison Department of Biochemistry
                 433 Babcock Drive, Madison, WI 53706-1544 USA
                     Phone: 608-262-3173 Fax: 608-262-3759

        NMRFAM Service Times are Tuesdays 1:00 p.m. CST to 5:00 p.m. CST
                  and Thursdays 1:00 p.m. CST to 5:00 p.m. CST
               NOTE: Times are subject to change without notice.

            NMRFAM SERVICE SPECTROSCOPY / SERVICE TIME REQUEST FORM

         Print or type your entries into this form and bring this form
                 when sample is brought to the NMRFAM Facility.


GENERAL INFORMATION
                                                        
Date of Sample Submission: __________________________________________________

Name of Person Submitting Sample: ___________________________________________

Sample Description: _________________________________________________________

Address: ____________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Phone: (_____)-_______-____________

Principal Investigator: _____________________________________________________

PI's Address: _______________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________

Phone: (_____)-_______-____________


BILLING INFORMATION

Allocate percentages if more than one Grant is to be charged.

______% 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). Signature is not needed if signature is already on file at NMRFAM
for this project,

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SAMPLE SPECIFICATIONS

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 more 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?

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


SAMPLE TEMPERATURE

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


SAMPLE HAZARDS

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

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USER CHARGES

See current spectrometer fees at http://www.nmrfam.wisc.edu/instrumentation


PARKING PERMITS

Parking permits are available for outside users by making arrangements in
advance with UW-Madison Parking and Transportation, 124 WARF Building,
Madison, WI 53705 Phone: 608-263-8683


REQUIRED PUBLICATION ACKNOWLEDGEMENTS

You must acknowledge NMRFAM in all publications that include data collected
or analyzed at NMRFAM with the following statement: 

"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."