MALDI-MS SAMPLE SUBMISSION FORM
                   Please submit form with samples 
                  Location: Medical Science Building Room 370
                    Hours: Monday to Friday 9am to 5pm
                    Contact: (519) 661-2111 ext. 82806
                                 Date: _____________________
       User Information
          Name:
          Email:
          Supervisor:
          Department (Address if off-campus):
          Speed code or PO:
       Sample Information
       Sample Name/ Type (e.g. protein/peptide, lipids, DNA) / Number of samples:
       Molecular mass / Mass range of interest / Digest (indicate species and enzyme)
       Molecular formula / Structure / Sequence (if known, please attach):
       Modifications (e.g. Phosphorylation):
       Sample Amount (concentration / mass):
       Please circle: a) Powder (Indicate solubility: water, acetonitrile)
              b) Solution (List all components and concentrations: buffer, salts, detergent)
       Preferred matrix, if known (e.g. CHCA, SA, DHB):
       Please circle: a) User will be spotting samples 
              b) Samples will be spotted by Facility staff 
       Please circle:     a) MS
                                 b) MS / MS
       Analysis & File Format Requested (e.g. ID Search, Text File, PDF):
       Rev.  March 2015