First name *
Last name *
Job title *
Company *
Department
Address *
City *
State
- None - Alabama Alaska American Samoa Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Marianas Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming
Postal code *
Country *
- Select - Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Caribbean Netherlands Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo (Brazzaville) Congo (Kinshasa) Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong S.A.R., China Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands North Korea Norway Oman Pakistan Palau Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu U.S. Virgin Islands Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe
Phone number
Fax
Email *
Instrument name *
Instrument serial number
Instrument catalog number
Heating device serial number *
Is your lab a commercial testing facility? *
- Select - Yes No
Is your lab a regulatory testing facility? *
- Select - Yes No
If other, please specify
Type of research/testing you do? *
If other, please specify
How often do you use Organomation's equipment? *
- Select - Daily Weekly 2-3 times weekly Monthly Seasonally/project based Other
If other, please specify
Do you evaporate to dryness? *
- Select - Yes No
What type of methodologies do you use? *
- Select - USGS EPA FDA AOAC EPH Other
Method number or other
Is this your first time using Organomation equipment? *
- Select - Yes No
If no, have you ever had to repair or service our equipment?
- None - Yes No
Have you used other nitrogen evaporators? *
- Select - Yes No
If other, please specify
Which model(s) have you used?
Do you use the equipment in a fume hood? *
- Select - Yes No
How many fume hoods do you have in your lab? *
- Select - 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
How often do you work with acidic or corrosive chemicals with evaporation equipment? *
- Select - Daily Weekly Monthly Yearly Never Other
If other, please specify
How many people work in your lab? *
- Select - <10 10-15 15-20 20-25 25-30 >30
How many people work for your company? *
- Select - <10 10-15 15-20 20-25 25-30 >30
Did you purchase this equipment directly from Organomation or through a distributor? *
- Select - Directly Distributor
If a distributor, which one?
How do you primarily purchase lab equipment? *
- Select - Directly Distributor
How did you learn about our equipment? *
- Select - Referred by colleague Social media Search engine Trade Show/Convention/Conference Method (EPA, FDA, etc.) Referred by supplier I used Organomation equipment in another lab I have Organomation equipment in my lab Other
If other, please explain
Specifically, why did you choose Organomation equipment over other products? *
Is there anything you would change to make our equipment work better for what you do?
