NHML Sample Request Form

Please fill out the fom below to send NHML your sample request via email. Fields with marked with an * are required.
You can also print this form and mail in your sample request. (Print form is in PDF Format - Requires Adobe Acrobat Reader)

 

22 Interstate Drive, Somersworth, NH 03878
Phone: 603-692-4110   •    Fax: 603-692-4008
 
Date:
PO #:
*Company Name:
*Contact Name:
Mailing Address:
City:   State: Zip:
*Email Address: Phone:
 
 
Quantity:
P/N:
Description:
Testing Requirements:
Alloy Verification   EDS  
Chemical Analysis   FTIR  
Mechanical Testing   Other
Failure Analysis      
         
 
 
Quantity:
P/N:
Description:
Testing Requirements:
Alloy Verification   EDS  
Chemical Analysis   FTIR  
Mechanical Testing   Other
Failure Analysis      
         
 

 
Quantity:
P/N:
Description:
Testing Requirements:
Alloy Verification   EDS  
Chemical Analysis   FTIR  
Mechanical Testing   Other
Failure Analysis      
         
 
 
Quantity:
P/N:
Description:
Testing Requirements:
Alloy Verification   EDS  
Chemical Analysis   FTIR  
Mechanical Testing   Other
Failure Analysis      
         
 

Sample Disposition   Check One
(Unless noted, all samples are discarded after 30 days of storage.)
Return Samples Collect - UPS / FEDEX #:
Return Samples - Include cost on final invoice
How did you hear about us?
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