CHEMICAL ANALYTICAL TESTING SERVICES REQUEST FORM



|Internal Use Only(内部专用) |Quotation No.:       Project No.:       Sample Received Date:       Due Date:       |

|1 Application Information 申请人信息 |

|Company Name/公司名称 |      |

|Address/地址 |      |

|Contact Person/联系人 |      |Phone/电话 |      |

|E-mail/邮箱 |      |Fax/传真 |      |

|2 PAYER/付款单位 Same as 1/同 1 If different from the above, as below 若付款单位与上述不同, 如下 |

|Company Name/公司名称 |      |

|Address/地址 |      |

|Contact Person/联系人 |      |Phone/电话 |      |

|E-mail/邮箱 |      |Fax/传真 |      |

|3 Type of Invoice 发票种类 VAT Special Invoice 增值税专用发票 VAT Regular Invoice 增值税普通发票 |

|4 Sample Information 样品信息 Description/pictures are attached /具体型号和产品图片见附件 |

|Sample Description/样品描述 |      |SAMPLE ATTACHED |

| | |附样 |

| | |      |

|Fiber Content纤维成分 |      | |

|Style/Model No./货号/型号 |      |Age Group/年龄阶段: |      | |

|P.O./Order No./订单号 |      |Sample Amount样品数量: |      | |

|Color/颜色 |      | |

|Fiber Content/成分 |      | |

|Manufacturer/生产商: |      |Exported to/出口到 |      | |

|Product End Use/最终用途 |      | |

|Care Label Instruction/水洗指示 | | |

|[pic] [pic] [pic] [pic] [pic] | | |

|Pre-Quality Test/预测试 |Yes, Client Name/客户名称:                           No |

|Retest/重测 |Yes, previous report number/是，原始报告号:      No否 |

|Return sample(s) 退回样品： |pay by client/由客户付费快递 pick-up by client/客户自行提取 |

| |（* Default to no need to return if tick boxes are blank.无勾选则默认为不需退板） |

|5 Test(s) Required 测试要求 (Please tick appropriate boxes 请在适当空格内勾选) |

|ISO (INTERNATIONAL)/国际标准 |BS (U.K.)/英国标准 |AATCC/ASTM (U.S.A.)/美国标准 |

|DIN (Germany)/德国标准 |China/国家标准 |JIS(Japan日本) |

|Physical Test/物理测试 |

|Yarn Size纱线支数 Seam Slippage接缝滑移 Seam Strength接缝强度 Fabric Count织物密度 Fabric Weight面料克重 Tearing Strength撕裂强力 |

|Tensile strength断裂强力 Bursting顶破强度 Abrasion Resistance 耐磨性能 Stretch and recovery 弹性回复 |

|Water Repellency (Spray Test)抗拒性(喷淋测试) Water Resistance 抗水性 Hydrostatic Pressure Test静水压测试 Oil Repellency拒油性 |

|Pilling抗起毛起球性能：Original Sample/原样Sample after wash//洗后,number of wash cycle(s)洗涤次数      |

|Dimensional stability& Appearance Retention尺寸稳定性&洗后外观 |

|Care Label verification/Recommendation 水洗指示验收/建议Laundering Test/洗涤测试 Shrinkage after washing/洗后的缩水率 Machine Wash/机洗 |

|Dry Clean/干洗Hand wash/手洗 Appearance after washing/dry clean/是否加做外观(No. of wash cycle(s)洗涤次数     ) Other /其它      |

|Fiber Composition Test/纤维成分测试 (请注明测试方法 Please specify test method)      |

|Flammability Test /燃烧性能 |

|CFR 1610 |ASTM D1230 |CFR 1615/1616 |ASTM D4151 |

|Colorfastness Test/色牢度测 |

|Washing水洗色牢度** |Dry cleaning小样干洗色牢度** |Crocking摩擦色牢度 |Water水浸色牢度 |

|Sea water海水浸色牢度 |Chlorine bleach氯漂色牢度 |Non-chlorine bleach非氯漂色牢度 |Light/日晒色牢度 |

|Saliva/唾液色牢度 |Perspiration/汗浸色牢度 |Phenolic Yellowing酚类泛黄 |

|ACCESSORIES TEST辅料测试 |

|Zipper Strength拉链强度 Attachment Strength附件强力 Specification of Drawstrings绳索安全性 |

|Analytical Test/分析测试 |

|Formaldehyde 甲醛含量 |pH Value 酸碱度测试 |Banned Azo Dyes 禁用偶氮染料 |

|Phthalates 邻苯二甲酸盐含量 |Total Lead Content 铅含量 |Dimethyl fumarate 富马酸二甲酯 |

|Chlorophenols (PCP/TetraCP/TriCP) 氯代苯酚 |Tin Organic Compounds有机锡化合物 |Allergising  Disperse Dyes (ADD) 致敏染料 |

|Carcinogenic Disperse Dyes  (CDD) 致癌染料 |Alkylphenol ethoxylate (APEO) 烷基酚聚氧乙烯醚 |Perfluorooctane sulfonate (PFOS) 全氟辛烷磺酸 |

|Chlororganic Carriers (CoC) 有机氯载体 |ortho-Phenyl phenol (oPP) 邻苯基苯酚 |Soluble Heavy Metals可溶性重金属测试 |

|Others Tests其他测试 (Please indicated test method if possible or special request) 请注明测试方法或其他特殊要求(可使用附页说明)            |

|Service Type: | Regular (standard price) (5-7working days) 普通件(5-7个工作日) |

|服务类别 |Express (50% Surcharge) (3working days) 特快( 加收50％附加费) (3个工作日) |

|Report Delivery 报告送递: Self pick-up自取 Express delivery快递 |

| We do not accept the testing from subcontractor of Eurofins (If no choice, regarded as accepted) 本公司不接受Eurofins以外的分包检测(如未选择，视为接受)。 |

|We request for the above tests and agree that all testing will be carried out subject to Eurofins Testing Technology (Shenzhen) Co., Ltd scale of charges as set |

|forth in their latest price list of which we have seen a copy and upon and subject to the terms and conditions set out hereon and overleaf. |

|Authorized signature & company chop授权签名及公章:      |Date日期:      |

|Be sure on filling above information. Additional fee would be charged if revision were required after issuing original report.. 以上资料请确实填写，报告完成后如需 |

|修改报告，将收取报告修改费。 |

|Once by signing the application form, the Applicant accepts the General Terms and Conditions (AGB) of Eurofins Testing Technology (Shenzhen) Co., Ltd. You can find|

|and download these in our website: |

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