Request for Single Crystal X-ray Structure Determination

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*Submitter Name:

*Sample Name:

*Date Submitted:

*Email:

Telephone/Room Number:

Molecular Formula or Elements Present:

Molecular Weight:

Advisor:

FOP:

Method of Preparing Material:

Crystallization Method and Solvents:

Select all that apply:

Unit Cell Only

Data Collection Only

Refined Structure

Comments and Hazard Details:

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Air Sensitive?

Loses Solvent?

Temperature Sensitive?

Temperature Experiment?

Temperature Range and Step Size:

Additional Comments:

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