Customer Satisfaction Survey

Test Request Form
(Not for UN Certification Use)

DATE:
NOTE: Completed form must be returned to gh Testing within 24 hours to confirm quote or job order

NewRetest (pack, product, or test change)

Test timeframe:

Company Address:

Name:

Company:

Address:

Suite:

City:

Phone:

State:

Zip Code:

Test Requested

Note: Requires Atmospheric Conditioning, mark below.
Note: Optional Atmospheric Conditioning. It you wish to have conditioning, please mark the appropriate box below (additional cost)

NMFC Test Procedure: 180 (LTL)181 (LTL)

Fed Spec or MIL SPEC:

ASTM:

Test Assurance LeveIIIIII

Distribution Cycle (1 - 18)

Individual Test(s) or test data specifics - ASTM Method (list specific requirements in Comments below):

Materials test:
Incline/Impact:
Environmental:
Compression test:

Vibration:
Drop test:
Shock test:
Stacked for more than 24 hours?: YesNo

Maximum Stack Height:
(if known) (For ISTA 2A/2B: Unless specified, the stack height is 270 inches)

For reference: 15 foot warehouse = 180 inches, tractor trailer = 110 inches

Safety Factor:
(if not known, the recommended Safety Factor for the procedure will be used)

Company-specific Test Requirements (must be attached)
OTHER TESTS/ADDITIONAL COMMENTS (provide test details, specification requirements, including any fixture requirements):

Note: If these fields are not indicated, gh Testing will use the recommended Heights and Safety Factors as required by the standard being used.

Environmental Conditioning

ISTA Conditioning: Select the most appropriate or severe condition the pack may encounter (The most common is Tropical Wet)
Extreme Cold: 72 hours at -20°F (-29°C) at an uncontrolled RH
Cold, Humid: 72 hours at 40°F (5°C) at 85% RH
Controlled Conditions: 72 hours at 72°F (23°C) at 50% RH
Hot, Humid: 72 hours at 100°F (38°C) at 85% RH
Elevated Temperature: 72 hours at 120°F (50°C) at an uncontrolled RH
Extreme Heat (Dry): 72 hours at 140°F (60°C) at 15% RH
Severe Cold: 72 hours at 0°F (-18°C) at an uncontrolled RH
User Defined:

High: 72 hours at
°F at % RH
Low: 72 hours at
°F at % RH
Cycle:
(Total time must be a minimum of 72 hours)

Other Conditioning:
(You may still select conditioning above if those are the conditions which you wish to test)

Internal Office Use Only:

Test Information:

Please define your acceptance criteria (what makes the pack acceptable upon receipt) - check all that apply:

Criteria 1 - Product is damage-free
Criteria 2 - Package is intact
Criteria 3 - Confirm product operation
Customer will inspect pack/product onsite for acceptance

Customer will inspect pack/product offsite for acceptance
Other - describe:

Test Information (continued):

Does pack contain fragile/temperature sensitive items?YESNO
Do you require photographs of the test?YESNO
Do you require photographs of visible damage?YESNO
Do you require a video of the test and visible damage?Y-VideoNO
Do you require test consultation upon test completion?YESNO
Do you require measurement uncertainty? (Only necessary for accredited tests, fee applies)YESNO
Constructive feedback from last test (if applicable):

Package/Product Information:

Product information:

ISTA: YESNO

NMFTA (Item 180/2F, Item 181) YESNO

(Test and pack information to be sent to ISTA and or NMFTA. You will then be contacted regarding the certification)

If yes, the following section must be filled out or complete packaging specifications must be submitted prior to the certification being issued

General Description of Pack:

(Please Send all Specifications on the pack, i.e. Inner Pack Type, Box Dimensions, and Type)

Please describe in detail the packaging materials utilized:

Interior Packaging:

Other:

Disposition of Pack/Product Upon Test Completion:

Dispose Of (non-hazardous materials only)

Return when finished to:

Address:
Preferred Carrier:

Confirmation:

I certify that this is an accurate description of the pack/product as submitted for test. Pack/product information has been described above and/or attached to this document.

Authorized Company Representative

Date

gh Testing Client Information Sheet

Main Contact Information (Required)
Company:
Name:
Street Address:
City, State, Zip:	, ,	Email:
Business Phone:		Mobile:
Report sent by:	Mail:	Email:

Report Sent To (if different than Main Contact)
Company:
Name:
Street Address:
City, State, Zip:	, ,	Email:
Business Phone:		Mobile:
Report sent by:	Mail:	Email:

Alternate / Additional Project Contacts
Name	Company	Email	Phone

Accounts Payable Information (Required)
Account Payable Company:
Accounts Payable Contact Name:
Bill To Street Address:
City, State, Zip:	, ,	Email:
Business Phone:

Billing Details (Required)
Payment Terms:	Net 30 unless otherwise attached
Preferred Billing Method	Mail:	Email:
Preferred Payment Method	Check:	Credit Card:	EFT:
If paying by credit card, gh Testing will contact the person listed as the Main Contact for further information when testing is complete. If using EFT, details will be sent at the time of invoicing.
Additional Notes:

Internal Info
Sales person:
Entered into database by:

Test Request Form (Not for UN Certification Use)

Test Request Form
(Not for UN Certification Use)