Applicant Name : / ______/ Official Use Only
______/ Rpt. No.:
Address: / ______
______/ Deposit :
Contact Person : / ______/ Telephone: ______/ Fax:______/ Zip: ______
Company Name & Address shown on Test Report (if different from the Applicant Name Above):
______
Payer Name : Same as Applicant Different, Please Specify (Name/Address.Contacted Person,Telephone, Fax): ______
Report Delivered To: Applicant Payer Invoice Delivered To: Applicant Payer
Sample Description/ Item Name : ______/ No. of Sample Submitted：______
Age Group for testing ：______
Item/Article/Model/ Style No.______/ Packaging Provided: Yes No
Buyer’s Name:______/ Goods Exported to: ______
Supplier/ Vendor/ Manufacturer:______/ Country of Origin: China ______
Tests Required: (Please tick appropriate boxes)
US ASTM F963-07Є1
Physical and Mechanical Tests Flammability Test - Solid / Fabric
Heavy Metals Test
Battery Operated Toys Test
Stuffing Cleanliness
DEHP Content
LHAMA ASTM D4236
US CPSC Regulation
Physical and Mechanical Tests Flammability Test
Lead Content Test
Lead Content Test in JewelryUS CPSIA 2008
Lead Contentin Paint (600ppm / 90ppm)( Exclue Use & Abuse tests when determining accessibility)
Lead Contentin Substrate (600ppm / 300ppm)
( Exclue Use & Abuse tests when determining accessibility)
Phthalates Content
Canadian Hazardous Products (Toys) Regulation
Physical and Mechanical Tests Flammability Test
Toxic Element Test
China Standard GB6675 /
European Standard
EN71 Part1 Physical and Mechanical Tests EN71 Part2 Flammability Tests
EN71 Part3 Toxic Element Test
EN71 Part6 Graphical Symbol for Age Warning Labeling
EN71 Part9 Organic Chemical Compounds- Requirement
EN62115 EMC
Phthalates Content 2005/84/EC
Cadmium Content 91/338/EEC / UK / Sweden/ Netherlands / Germany
EU RoHS Directive
Australia /New Zealand StandardAS/NZS ISO 8124 part1 Physical and Mechanical Tests
AS/NZS ISO 8124 part2Flammability Tests
AS/NZS ISO 8124 part3Toxic Element Test
Battery Operated Toys Test
Other TestsModel Toxic in Packaging Legislation (CONEG)
94/62/EEC Toxic Element Test on Packaging Material
Colour Fastness to Perspiration and Saliva German LMBGAzo Dyes (EU / Germany / Netherlands / Austria)
Nickel Release （ EN1811 / EN12472)
NPEO+ OPEO
Others (Please specify):
/______
______Service Required: / Regular / Express (40% surcharge) / Shuttle(100% sur charge) / Same Day
Report Service : / Fax / Mail / Express Mail / Self Pick-Up
Return Sample: / Yes / No / English Report—Default / Chinese Report / Chinese＋English（Surcharge USD$27）
Insert sample photo / Yes (USD$6.2for color photo) / Yes (free chargefor white/balck photo) / No / CNAS Report / Yes No
UKAS Report / Yes No / UK Joint Report / Yes No / NF Joint Report / Yes In English Bilingual / No
Some of tests above will be subcontracted to Intertek Testing Services labs.
Agree, Confirmed by Telephone Email Fax Other Disagree
We request for the above tests and agree that all testing will be carried out subject to INTERTEK TESTING SERVICES 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.
*Be sure on filling above information. Additional fee would be charged if revision were required after issuing original report.
Date: / Authorised Signature and
Company Stamp of the Payer:
P.T.O.For terms and conditions)
Notes : / 1.Applicant should retain the Duplicate for own reference and present the same for collection of test report in our office.
2.No comment may be given for some of the test items if related standard or specification is not available.
INTERTEK TESTING SERVICES LTD., SHANGHAI
Block B, Jinling Business Square, No.801 Yi Shan Road, Shanghai 200233, China
Tel: 0086－21－61206565, Fax: 0086－21－61279709/91279740 Zip: 200233