*Mandatory Field (Must Be Completed Or Sample Will Be Placed on Hold)

*Mandatory Field (Must be completed or sample will be placed on hold)

Submitting For: Nordstrom, Inc. / JDE Number: 50607 / Submitter: / Contact:
Submitter Address: / Email:
Service Requested: (select one) / Regular (4 working days) / Rush (3 working days) / Express (1 working day)
*NPG Contact (Product Developer):
Sourcing Category: Choose an item. / If other please list:
Performance Standard: / Men’s shoes / Women’s shoes / Men’s or Women’s Boots / Active footwear / NPS-10 Slippers
*Division: / Department: (select from drop-down)
Footwear / *NPG Department: / Choose an item. / If other, please list:
*Label Name (E.G. Calibrate, Caslon, etc.):
*Nordstrom Style (VPN) Number(s): / PO Number(s): (If multiple, please list separately)
Ship Date: / *Season: Choose an item. / *Year (YYYY):
Agent: Choose an item. / If other, please list name:
*Agent Contact Name: / *Agent Email Id:
*Manufacturer Name: / Manufacturer RMS Number:
*Manufacturer Contact Name: / *Manufacturer Email Id:
*Factory Name: / Factory RMS Number:
*Factory Contact Name: / *Factory Email Id:
Factory Address: City: State: Country: Postal Code:
*Product Description: / *Submitted Color(s) / Print Name:
Footwear Size: / Footwear Components:
Footwear: External Surface area of upper (Fabric, Leather, etc,):
Footwear: External Surface area of sole (Leather, fabric etc.):
*Stage of Testing: / Development / Production

TEST REQUIRED:

Men’s Footwear Critical Test Package / Women’s Footwear Critical Test Package
Men’s & Women’s Boots Critical Test Package / Adult Active Footwear Critical Test Package
Men’s & Women’s Indoor & Outdoor Slippers Critical Test Package
Other:
Retest - Previous Report Number:
Additional/Reference Information:
Technique(s) used to improve the failure:
(Mandatory for all retest submissions)
Return Sample: / No / Yes (shipping and handling charges apply)

BILLING INFORMATION:

Bill to agent, manufacturer or factory only. If Nordstrom is selected, lab will contact submitter for alternate billing party.

Bill to Company: / Contact Person:
Address: / Phone:
E-mail: / Fax:
Date: / Authorized Signature:

FAILURE TO COMPLETE THIS FORM ACCURATELY WILL RESULT IN RETESTING THE ITEM AT MANUFACTURER/VENDOR’S OWN EXPENSE.