North Carolina State University
NMR Facility

Date submitted:__________________________

                                                     Check one
Request for Spectrometer Time*      (   )
Request for Spectral Analysis          (   )

Name ____________________________________      Phone      ____________________________
P.I.  _____________________________________       Account No. ____________________________
Dept. ____________________________________       Signature      ____________________________

Instrument:
Solution: Varian600( ), Bruker500( ), Mercury400 ( ), Mercury300 ( ), GN300 (   ), Data station* (   )
Solid-state: Chemagnetics 200 (   )

Nucleus to be detected: 1H (   )  13C (   )  Other(s):___________________________
Type of experiment:  1D-FT (   ) 2D-FT ( ) Other(s):_____________________________________
Probe requested*: ________________________________________
Total hours needed*: ____________________________      Preferred dates*: ________________________
* not applicable to those who submit samples

SAMPLE INFORMATION:
Sample amount(s): _____________________________      Solvent: _______________________________
Molecular weight: ______________________________      Reference: TMS (   ) Other: _________
Sample soluble in: H2O       MeOH     CHCl3      CH3CN        THF     Acetone        DMSO       Other:____________
Is sample:
Stable under acidic conditions     Yes     No
Air sensitive                                Yes     No
Light sensitive                             Yes     No
Store in freeze                            Yes     No
Proposed structure and sample name(s):
1.)
 

2.)
 

3.)

Special Requirements:____________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
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Operator:____________________ Time in:_______________________ Time out:_______________________
                  Time/ Date    Time/ Date
File name(s):______________________________________________________________________________
Prime time: _________ ____hrs + Extended time: _____________hrs = Total time used: ______________hrs