Analytical and Biochemical Services Request Form Please complete this form and submit with your sample(s), safety data, and payment information.

By sending samples in accordance with this form, the submitter agrees that AMRI SSCI, LLC ("WLF") shall perform the services set forth herein andfurther agrees that the work conducted is governed by AMRI DDA standard terms and conditions (AMRI DDA Terms and Conditions) unless anagreement for the provision of services, such as a master services agreement, is in place between the parties, in which case that agreement governs these services. No other terms or conditions, such as those found on purchase orders, apply.

Analytical and Biochemical Services Request Form (Revised July 2019) Page 1 of 2

Shipping Date: Company:

Name of Submitter: Address:

E-mail:

Purchase Order: (P.O. or payment info is required to begin testing. Invoice will be sent to Accounts Payable of submitting company unless otherwise specified.)

Other Billing Info: Phone:

Number of Samples: Compound Name: (If necessary for data analysis, please provide structure.)

WLF Quote/Proposal No.:

Storage and Handling Information:

Storage Conditions: Molecule Type:

Ambient Small molecule organic Refrigerator Peptide Std. Freezer Protein −80 °C Freezer Oligonucleotide Light sensitive Inorganic

Contains element heavier than chlorine? Refrigerated or frozen sample: How long may it be kept at ambient conditions during sample prep and analysis (default is 8 hours)? _________________________________________________________________

Other safety/handling information: _________________________________________________________________

Analytical and Biochemical Services Request: (see page 2)

Please indicate purpose of analyses General Information FDA Submission Lot Release * * Lot release often requires a validated, product-specific method. Please contact WLF for further information.Has WLF previously analyzed this compound? Yes No Should this data be compared with previous WLF data? Yes No

If yes, please include the report number(s) and/or sample ID(s) to be used for comparison. An hourly charge will be incurred for this service.

Comments: ____________________________________________________________________________________________________________

Report and Priority Options:

Interpretative (includes hourly charge for data interpretation)

Standard turnaround (7-10 business days for most techniques. Contact WLF for details.)

3-day Rush Service for XRPD, IR, Raman, TGA, DSC, or microscopy(50% surcharge; results via e-mail in 3 business days;report within 5 business days)

1-day Urgent Service for XRPD, IR, Raman, TGA, DSC, or microscopy(100% surcharge; results via e-mail by next business day;report within 4 business days)

Non-interpretative (not available for techniques where interpretation is needed)

Standard turnaround (5 business days for most techniques. Contact WLF for details.)

3-day Rush Service for XRPD, IR, Raman, TGA, DSC, or microscopy(50% surcharge; results via e-mail in 3 business days;non-interpretative report within 4 business days)

1-day Urgent Service for XRPD, IR, Raman, TGA, DSC, or microscopy(100% surcharge; results via e-mail by next business day;non-interpretative report within 3 business days)

NOTE: For expedited service for other techniques, contact WLF for availability, price, and turnaround time. No _____________________________________________ Should WLF send your signed final report via e-mail (PDF)? Yes

An electronically signed PDF report will be provided via e-mail or CD if email is not requested. (E-mail address if different than submitter)

Sample Shipping:

Phone: 765-463-0112 or 800-375-2179 Fax: 765-463-4722 E-mail: wlf_info@amriglobal.com

Sample Receiving AMRI SSCI, LLC3065 Kent Avenue West Lafayette, IN 47906-1076

WLF accepts sample deliveries Monday through Friday, except holidays, from 8:00 AM until 4:00 PM (Eastern). To deliver a sample at an alternativetime, please call and arrange in advance.

Sample Disposition:

DESTROY SAMPLE(s) no less than 30 days after completion of project. DEFAULT option, if no other instructions provided. RETURN SAMPLE(s) by FedEx Ground at no additional cost (non-hazardous materials, ambient conditions only). Provide address if different than provided above. Returned samples are not suitable for human consumption.

Payment: Invoicing will occur upon completion of report and is to be paid according to the Agreement terms.

Normal (OEL ≥ 1 µg/m3)High Potency (OEL < 1 µg/m3; surcharge may apply) Controlled Substance (DEA Schedules I-V; 25% surcharge)

Special Handling:

WLF reviews all available safety information prior to starting projects.

https://www.amriglobal.com/wp-content/uploads/DDA-Terms-and-Conditions-Jan.-2019.pdf

Analytical and Biochemical Services Request Form (All analyses are performed in compliance with cGMP unless noted.)

Page 2 of 2

Company: Compound Name: WLF Quote/Proposal No.:Use additional Sample Submission Forms (from website) when submitting more than 4 samples. All pages must be submitted with Page 1 of the WLF Analytical and Biochemical Services Request Form.

Weight:Thermal Analysis

* Differential Scanning Calorimetry (DSC, 5 mg)

Modulated DSC (mDSC, 5 mg)

Microcalorimetry (non-GMP, 100-500 mg)

nano-DSC (non-GMP, 1-5 mg)

* Thermogravimetric Analysis (TGA, 5 mg)

TG-IR (TGA coupled to gas-phase IR, 5 mg)

Thermal Microscopy (hot/cold stage, 1 mg)

Spectroscopy and X-ray Diffraction

* Infrared Spectroscopy (IR, 1 mg)

IR microspectroscopy (1 mg)

Mass Spectrometry, ESI (1 mg)

Mass Spectrometry, APCI (1 mg)

Mass Spectrometry, MS/MS (1 mg)

Mass Spectrometry, MALDI-TOF (1 mg)

Mass Spectrometry, Q-TOF (1 mg)

Near IR Imager (50 mg)

NMR, liquid, 1H,

19F,

31P (1-5 mg)

NMR, liquid, 13

C or other (10-100 mg)

NMR, solid state, 13

C, 31

P, 15

N, 19

F, 29

Si (30-40 mg)

* Raman Spectroscopy (10-100 mg)

Raman Microscopy (1 mg)

UV/Vis spectrophotometry (5-10 mg) * X-ray powder diffraction (XRPD, 15-100 mg)

XRPD Indexing (data analysis option)

XRPD, variable temperature or variable humidity (50-200 mg)

XRD, single-crystal structure (non-GMP)

Microscopy and Physical Characterization

Density, bulk only (>10 g)

Density, bulk and tapped (>10 g)

Dissolution (intrinsic, paddles, baskets) Energy Dispersive X-ray (EDX), includes SEM images (1 mg)

Karl Fischer water titration, coulometric

Karl Fischer water titration, volumetric

Particle size (Malvern laser scattering, 0.1-2 g)

* Polarized Light Microscopy (1 mg)

* Scanning Electron Microscopy (SEM, 1 mg)

Surface Area (BET method, 0.5-5 g)

Vapor sorption/desorption (DVS, 20 mg)

Biochemistry and Chromatography

Amino Acid Analysis (2 mg)

Assays (UV, Colorimetric, or Fluorescent)

Dynamic Light Scattering (DLS)

Gel Electrophoresis (SDS, IEF, native)

U/HPLC (RP, IC, SEC, chiral)N-terminal Sequencing

Peptide Mass Fingerprinting (Q-TOF MS)

Peptide Mapping (UV detection or LC-MS)

SEC-MALS

WLF Received By Initials: WLF INTERNAL USE ONLYDate and Time Samples Received at WLF:

Analytical and Biochemical Services Request Form (Revised July 2019)

Lot No / Sample ID:

* Stereomicroscopy (1 mg)

(* Rush and Urgent services are available for most techniques upon request. 3-Day Rush (50% surcharge) and 1-Day Urgent (100% surcharge) services are available only for XRPD, IR, Raman, DSC, or microscopy except when the testing requires a compendial or validated method.)

Specific Analysis Conditions/Details:Standard analysis conditions will be used unless otherwise specified.

Osmolality (1 mL)

Shipping Date: Name of Submitter: Email: Address 1: Address 2: Purchase Order: PO or payment info is required to begin testing Invoice will be sent to Accounts Payable of submitting company unless otherwise specified: Other Billing Info: Phone: Number of Samples: Light sensitive: OffNormal OEL must be 1 gm3: OffContains element heavier than chlorine: Offundefined: Other safetyhandling information: General Information: OffFDA Submission: OffLot Release: OffAn electronically signed PDF report will be provided via email or CD if email is not requested: OffEmail address if different than submitter: Specific Analysis ConditionsDetails: Date and Time Samples Received at SSCI: SSCI Received By Initials: Company: Compound Name: SSCI QuoteProposal No: StorageCondition: OffMoleculeType: OffReportType: OffReportPriority: OffSampleDisposition: OffSample ID_2: Sample ID_3: Sample ID_4: TA_2_1: OffTA_2_2: OffTA_2_3: OffTA_2_4: OffTA_2_5: OffTA_2_6: OffTA_2_7: OffTA_3_1: OffTA_3_2: OffTA_3_3: OffTA_3_4: OffTA_3_5: OffTA_3_6: OffTA_3_7: OffTA_4_1: OffTA_4_2: OffTA_4_3: OffTA_4_4: OffTA_4_5: OffTA_4_6: OffTA_4_7: OffTA_1_1: OffTA_1_2: OffTA_1_3: OffTA_1_4: OffTA_1_5: OffTA_1_6: OffTA_1_7: OffSXR_2_1: OffSXR_2_2: OffSXR_2_3: OffSXR_2_4: OffSXR_2_5: OffSXR_2_6: OffSXR_2_7: OffSXR_2_8: OffSXR_2_9: OffSXR_2_10: OffSXR_2_11: OffSXR_2_12: OffSXR_2_13: OffSXR_2_14: OffSXR_2_15: OffSXR_2_16: OffSXR_2_17: OffSXR_2_18: OffSXR_3_1: OffSXR_3_2: OffSXR_3_3: OffSXR_3_4: OffSXR_3_5: OffSXR_3_6: OffSXR_3_7: OffSXR_3_8: OffSXR_3_9: OffSXR_3_10: OffSXR_3_11: OffSXR_3_12: OffSXR_3_13: OffSXR_3_14: OffSXR_3_15: OffSXR_3_16: OffSXR_3_17: OffSXR_3_18: OffSXR_4_1: OffSXR_4_2: OffSXR_4_3: OffSXR_4_4: OffSXR_4_5: OffSXR_4_6: OffSXR_4_7: OffSXR_4_8: OffSXR_4_9: OffSXR_4_10: OffSXR_4_11: OffSXR_4_12: OffSXR_4_13: OffSXR_4_14: OffSXR_4_15: OffSXR_4_16: OffSXR_4_17: OffSXR_4_18: OffSXR_1_1: OffSXR_1_2: OffSXR_1_3: OffSXR_1_4: OffSXR_1_5: OffSXR_1_6: OffSXR_1_7: OffSXR_1_8: OffSXR_1_9: OffSXR_1_10: OffSXR_1_11: OffSXR_1_12: OffSXR_1_13: OffSXR_1_14: OffSXR_1_15: OffSXR_1_16: OffSXR_1_17: OffSXR_1_18: OffMPC_1_1: OffMPC_1_2: OffMPC_1_3: OffMPC_1_4: OffMPC_1_5: OffMPC_1_6: OffMPC_1_7: OffMPC_1_8: OffMPC_2_1: OffMPC_2_2: OffMPC_2_3: OffMPC_2_4: OffMPC_2_5: OffMPC_2_6: OffMPC_2_7: OffMPC_2_8: OffMPC_2_9: OffMPC_2_10: OffMPC_3_1: OffMPC_3_2: OffMPC_3_3: OffMPC_3_4: OffMPC_3_5: OffMPC_3_6: OffMPC_3_7: OffMPC_3_8: OffMPC_3_9: OffMPC_3_10: OffMPC_4_1: OffMPC_4_2: OffMPC_4_3: OffMPC_4_4: OffMPC_4_5: OffMPC_4_6: OffMPC_4_7: OffMPC_4_8: OffMPC_4_9: OffMPC_4_10: OffBC_1_2: OffBC_1_3: OffBC_1_4: OffBC_1_5: OffBC_1_6: OffBC_1_7: OffBC_1_8: OffBC_1_10: OffBC_1_9: OffBC_2_2: OffBC_2_3: OffBC_2_4: OffBC_2_5: OffBC_2_6: OffBC_2_7: OffBC_2_8: OffBC_2_10: OffBC_2_9: OffBC_3_2: OffBC_3_3: OffBC_3_4: OffBC_3_5: OffBC_3_6: OffBC_3_7: OffBC_3_8: OffBC_3_10: OffBC_3_9: OffBC_4_2: OffBC_4_3: OffBC_4_4: OffBC_4_5: OffBC_4_6: OffBC_4_7: OffBC_4_8: OffBC_4_9: OffBC_4_10: OffPrevisoulyAnalyzed: OffCompareWithPrevious: OffComments: Controlled Substance: OffHigh Potency: OffMPC_1_9: OffMPC_4_12: OffMPC_3_12: OffSample ID_1: Weight_1: Weight_2: Weight_3: Weight_4: MPC_2_11: OffMPC_3_11: OffMPC_4_11: OffMPC_2_12: OffMPC_1_10: OffMPC_1_11: OffMPC_1_12: OffMPC_1_13: OffMPC_2_13: OffMPC_3_13: OffMPC_4_13: Off