TEST REQUEST FOR PACKAGE TESTING

1A. Your Company Name & Address:

1B. Name and phone number of Contact:

1C. Purchase Order # for this test:

2. DESIRED TYPE OF TEST TO BE PERFORMED:

ISTA	WHAT ISTA LEVEL?
LTL (less than truckload)
ASTM 4169 (structured shipping simulation)
OTHER (please describe here briefly and provide your test method on fax or email)

3. PACKAGE CONFIGURATION:

3B. UNITIZED LOAD	WEIGHT & DIMENSIONS OF UNITS
UNITS PER LAYER	LAYERS PER PALLET

3C. PALLETIZED LOAD (please describe outer layers and assembly sequence here)

DIMENSIONS OF PACKAGE:

GROSS WEIGHT lbs

3D. PALLET/SKID CONFIGURATION (please include size, grade and material)

4A. OTHER STRUCTURAL COMPONENTS OF PACKAGE:

4B. PLEASE DESCRIBE STRUCTURAL COMPONENT DETAILS:

5. OUTER CLOSURE OR SEALING METHOD:

5C. STITCHED:	, NUMBER AND PLACEMENT OF STITCHES:
5D. OTHER CLOSURE DETAIL:

6. INNER PACKAGE IS/ARE:	TRAY
BOTTLE	PE BAG
INNER CARTON	METAL DRUM
OTHER (please describe details)

7. PRODUCT TESTED IN PACKAGE IS:

OTHER (please describe in detail)

PRODUCT MANUFACTURER IS

MODEL AND SERIAL NUMBER OF PRODUCT IS