Complex Carbohydrate Research Center

Request for Analytical Services

The CCRC offers custom synthesis and analysis of complex carbohydrates as a service to scientists in university, industrial, and government laboratories. Assistance is also offered to those who need information on complex carbohydrates derived from animal, plant, and microbial sources.

In order to initiate a service agreement, please fill out the following form. Please provide a purchase order number or supply credit card information for payment. International clients requesting analysis are required to submit payment in advance. We must receive this information prior to performing analysis of your sample(s)

Name:

Highest degree held:

Position:
Department:

Institution:

Mailing address:

Telephone number:
Fax number:
E-mail address:

Sample source: Sample name:

Animal

Plant

Bacterial

Fungi

Analysis requested:

Comments:

If payment of your analysis is to be made by purchase order, please provide the PO# and billing address below:

PO#:

Billing address:

Please indicate if you would like instructions for wire transfer.

The CCRC's analytical services are supported by funding from the US Department of Energy and the National Institutes of Health. We are required to document the funding information for this requested analytical service.
Source of current or planned funding for the project:
(Please include the PI, agency/organization, grant/contract number, and annual direct costs)

PI First Name:

PI Last Name:

Granting Agency/Organization:
Grant/Contract Number:

Annual Direct Costs:

In addition, we are required to document publications resulting from non-propritary service activity. Should any of the data obtained from this service be used in a publication, please let us know.

I agree to report published works that result from the CCRC's analytical services.
If you have published works (including 'in press') and/or presentation abstracts that result from service activities, please enter these below.
(Please provide full citation of publications and book chapters)

Thank you.

If you have trouble submitting this form, please contact Carol Connelly cconnelly@ccrc.uga.edu,
or mail the form to:
Carol Connelly
Complex Carbohydrate Research Center
University of Georgia
315 Riverbend Road
Athens, GA 30602-4712 USA

Thank you for your assistance.

Name:
Highest degree held:
Position:
Department:
Institution:
Mailing address:
Telephone number:
Fax number:
E-mail address:

PI First Name:
PI Last Name:
Granting Agency/Organization:
Grant/Contract Number:
Annual Direct Costs: