SAMPLE SUBMISSION FORM

 CLIENT DETAILS

 Client:______________________________________________________________________

Address:____________________________________________________________________

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Phone:______________________________________________________________________ 

Email:________________________________________________________________________

Contact:_____________________________________________________________

Date Shipped:________________________________________________________

 SAMPLE INFORMATION:

Product Designation:_____________________________________________________

Product Lot:____________________________________________________________

Quantity:_______________________________________________________________

Storage Conditions:______________________________________________________

Testing Required:_______________________________________________________

_____________________________________________________________________

Attach Product Data Card :  Required

Results Needed by:_____________________________________________________

 PO #_________________________________________________________________

Additional Comments:____________________________________________________

_____________________________________________________________________

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_____________________________________________________________________

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