DUPONT™TEFLON® HANGTAG ORDER FORM

Pleasecomplete this FORMand send with the DuPont™TEFLON®Brand Assurance Test Report for the fabric.
NOTE: If licensed Mill/Finisher is ordering hangtags, please also attach copies ofchemical purchase invoices.

The delivery of the hang tags requested does not imply nor grant the Retailer, Brand House or recipient, the right to reproduce or use the TEFLON® trademark and its diamond logo in any promotion, advertising or marketing except for placement of the hang tags on the identified end use goods. If companies are interested in rights to promote the TEFLON® trademark besides use of these hangtags, then please contact your DuPont representative for a Trademark User Agreement. Unauthorized use constitutes a trademark infringement penalized by law.

Region / Contact EMAIL / Tel: / Fax:
Americas / Nina Servino / +1-302-999-5539 / +1-302-996-7151
EMEA / John Painter / +44(0)1400 251422 / n/a

Asia Pacific

/ Andy Yee / +852 2734-1903 / +852 2734-5345
1. REQUESTOR: (Indicateone)> / Finisher/Mill / End Article Producer / Fabric Agent
REQUESTOR NAME / DATE:
COMPANY NAME: / TEL #:
EMAIL ADDRESS:

2. SHIPPING INFORMATION: (Must be end article producer only)

Company Name:
Delivery Address:
Postal Code: / Email:
Attention: / Tel: / Fax:
Courier/carrier account no. required if delivery is outside of region or overnight delivery needed:
Courier/carrier company name: / Account #to charge:

3. MILL/FINISHER INFORMATION:

Company Name: / Country:
Meters/Yardage: / Fabric Style No.
HUNTSMAN Certificate No.

4. END-USE INFORMATION

Apparel / Accessory Application: if other please describe

Garment Gender (X): Unisex Male Female Childrens Infants

Home / Interior Applicationif other please describe

NO. END USES PRODUCED

/ /

QUANTITY OF FABRIC: yd or mtr

/

RETAILER / BRAND HOUSE*

/ /

COUNTRY

/

CONTACT PERSON

/ /

PHONE / FAX / EMAIL

/
* Brand or Retailer name required. Orders without this information will not be fulfilled.
5. HANGTAG INFORMATION (hangtagimages and codes shown on page 2 and 3)
Shield and Clean Portfolio (short-chain)
New preferred hangtags
Hangtag Code K26975 Shield (outerwear/umbrella only)K26976 Shield+ (formerly REPEL)K26977 Shield Pro+ ( High Performance REPEL)K26978 Clean (formerly RELEASE)K26979 Clean+ (formerly High Performance RELEASE)K26981 Clean & Dry (formerly ULTRA RELEASE) K26980 Shield & Dry (formerly TRI-EFFECTS)K26982 Shield & Clean+ ( Advanced DUAL ACTION)K26984 General StickerK27893 Small Article (Accessory) TagK26992 Down and Feather K28368 Sew-in Bedding (cut) K28369 Sew-in Bedding (roll)
Regional Language NA - English / SpanishE - Eng, Fre, Ger, Spa, Ita, PorA - Eng, Chi, Jap, KorC - English / French
Quantity / --OR-- / Hangtag for Legacy Product (long-chain)
General Hangtag - Benefit specific phased out
Hangtag Code K-89761 General
Regional Language NA - English / SpanishE - Eng, Fre, Ger, Spa, ItaE7 - Eng, Rus, Pol, Turk, Czech, Hung(only K89761)A - Eng, Chi, Jap, KorC - English / FrenchJ - Japan (only K89786)
Quantity
TO BE COMPLETED BY HUNTSMAN
ORDER NUMBER / MILL CONFIRMED / TEST CONFIRMED
FLUOROCHEMICALS USAGE (VERIFIED BY HUNTSMAN SALES HEAD ) in KGS / NAME>

TEFLON is a DuPont registered trademark for its fabric protector. Only DuPont makes TEFLON. Rev: 6/2014