普通测试申请表

上海天祥质量技术服务有限公司普通测试申请表 General Testing Requisition Form Form No.:Applicant Name (Payer): _________________________________________________ Official Use Only 申请单位名称（付款单位）: _________________________________________________Rpt. No. :Address:_______________________________________________________________申请单位地址:__________________________________________________________Contact Person 联系人: ___________ Telephone 电话：__________________Fax 传真：__________ 邮编：____Report Address 报告寄往:_______________________________________________Email 地址:_________________Company Name & Address shown on Test Report (if different from the Applicant Name Above):测试报告上所注明的单位名称及地址（如果与以上申请单位不符）：Sample Description 样品描述 Item/Article/Model/Style No. 式样编号 Qty. of Sample Submitted 样品数量Buyer 买家 : ____________________________________ (可不填）P.O. No.:_________________________Supplier/Vendor/Manufacturer 供应商/贸易商/生产商:________________________________________________________ Goods Exported to 产品运往：___________________ Country of Origin 原产地:________________________ Test(s) Required (Please tick appropriate boxes) : 测试要求Please select the test from the listed standard as attached, if it is not in the list, please indicate the test standard or test method in this form. 请从所附的标准清单中选取测试标准，若不在其中，请在此注明测试标准或方法。

Service Required: ☐ Regular 普通件 ☐ Express (40% surcharge) 加急件☐ Shuttle (100% surcharge) 特急件Report Service : ☐ Fax 传真 ☐ Mail 挂号信 ☐ Express Mail 特快专递 ☐ Self Pick-Up 自取Return Sample:☐ Yes☐ No* Notice: Samples not destroyed during testing may be reclaimed if so written down on the application form and will only be retained for aperiod of 30 days. (测试完成后,如需退回样品, 请在报告签发之日起30天内来实验室凭报告号码提取。

)是否同意个别项目分包天祥集团内部其他实验室（Some of tests above will be subcontracted to Intertek Testing Services labs.） ☐ 同意 （Agree ） 经过确认（Confirmed by ） ☐ Telephone ☐ Email ☐ Fax ☐ Other ☐ 不同意 （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.*以上资料请确实填写，报告完成后如需修改报告内容，将收取报告修改费 Be sure on filling above information. Additional fee would be charged if revision were required after issuing original report.付款公司盖章及代表签名Date 日期Authorised Signature and Company Stamp of the Payer:(条款祥载背面)(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.上海天祥质量技术服务有限公司Intertek Testing Services Ltd., Shanghai Furniture 家具测试Seating 椅子板凳☐ ENV12520: Domestic Seating-mechanical and structural 家用椅凳 ☐ EN581-1&2: Outdoor seating-structural and Mechanical 户外椅子 ☐ EN1022 stability 稳定性☐ EN12727 Ranked seating- strength and durability 排椅强度和稳定性 ☐ BS 4875-1 seating strength and stability 椅子板凳强度和稳定性 ☐ ASTM F1561 Outdoor Plastic Chairs 户外塑料椅子☐ ASTM F1858 outdoor Multipositional Plastic Chair 户外塑料椅子 ☐ ISO7173 Chairs & stools-strength and durability 椅子板凳强度 ☐ ISO7174-1 Upright chairs and stools – stability 直背椅和板凳稳定性 ☐ ISO7174-2 tilting or reclining Chairs-stability 斜背椅稳定性 Office Furniture☐ EN 527 table and desk 办公桌 ☐ EN 1023 Screen 屏风☐ EN1335-1, 2&3: Office Chair 办公椅 ☐ EN12529 swivel chairs Castors 办公椅滑轮 ☐ BS 5459-2 Office pedestal seating 办公转椅 ☐ DIN 4551: office swivel chairs 办公转椅☐ ANSI/BIFMA X5.1 General Purpose Office Chairs 办公椅 ☐ ANSI/BIFMA X5.2 Lateral Files 横式档案柜 ☐ ANSI/BIFMA X5.3 Vertical Files 直式档案柜 ☐ ANSI/BIFMA X5.4 Lounge Seating 休闲椅 ☐ ANSI/BIFMA X5.5 Desk Products 桌子 ☐ ANSI/BIFMA X5.6 Panel Systems 屏风系列 ☐ AS/NZS 4438:Office Chair 办公椅 Table/Desk 桌子☐ EN12521: Domestic tables-mechanical and structural safety 家用桌 ☐ EN 581-1 &3: Outdoor tables –Structural and Mechanical safety 户外桌 ☐ BS7376 inclusion of glass in the construction of table or trolley 玻璃桌子 ☐ BS4875-5 tables and trolleys -Strength and stability 桌子强度稳定性 ☐ ISO 7172 Tables-stability 桌子稳定性 Storage furniture 橱柜☐ EN 1727 Domestic Storage furniture- Safety 家用橱柜安全 ☐ ISO 7170: Storage units-strength and durability 橱柜强度耐久强度 ☐ ISO 7171: storage units-stability 橱柜稳定性☐ BS 4875-8 non-domestic storage - Strength and stability 非家用橱柜强度稳定性☐ BS 4875-7 storage - Strength and stability 橱柜强度稳定性 Bed 床☐ EN716 domestic Children ’s cots and folding cots 童床 ☐ EN 747: domestic Bunk beds 双层床☐ EN 1957: Domestic Beds and mattresses - functional characteristics 床/床垫 ☐ EN 1129 Foldaway beds-Safety 折叠床☐ EN1725 Domestic Bed and Mattresses-Safety 床/床垫 ☐ ASTM F1427 Bunk bed 双层床 ☐ ISO 9098 domestic Bunk beds 双层床☐ GB/T 10357.6 beds-strength and durability 床强度耐久强度 ☐ AS/NZS 4220 Bunk Bed 双层床☐ 16 CFR 1508 +ASTM F1169 (ASTM F966) children’s cot 儿童床 Other☐ EN 1153: kitchen cabinets and work tops 厨房橱柜和台面 ☐ EN 12221 domestic Changing unit Material test for Furniture☐ BS7376 glass of tables or trolleys 桌子用玻璃 ☐ BS6206- impact performance for glass 玻璃冲击性能 ☐ ISO 8191-2: ignitability of upholstered furniture 家具套燃烧 ☐ Wood Formaldehyde Content 木制品的甲醛含量 Furniture Surface Resistance Test 家具表面测试 ☐ EN 12720 cold liquids 抗液性 ☐ EN 12721 wet liquids 抗湿热性 ☐ EN 12722 dry liquids 抗干热性 ☐ ISO 4211-1: cold liquids 抗液性 ☐ ISO 4211-2: wet heat 抗湿热性 ☐ ISO 4211-3: dry heat 抗干热性☐ ISO 4211-4: impact 冲击☐ ISO 8191-1 ignitability of upholstered furniture-smoldering cigarette ☐ SS 83 91 17 scratches 耐刮伤 ☐ SS 83 91 20 water 耐水☐ SS 83 91 22 fat on surface with scratches 带刮伤表面的耐油性 ☐ SS 83 91 23 impact on surface and edge ’s 表面和棱边的耐冲击上海天祥质量技术服务有限公司Intertek Testing Services Ltd., Shanghai Sporting Goods 运动器材☐ EN957-1&2:Strength Training Equipment 强度运动器材 ☐ EN957-1&4:Strength Training Bench 运动用长椅 ☐ EN957-1&5:Pedal Crank Training Equipment 健身车 ☐ EN957-1&6:Treadmills 跑步机 ☐ EN957-1&7:Rowing Machine 划船器 ☐ EN957-1&8:Steppers, Stair Climbers 踏步机 ☐ EN957-1&9:Elliptical Trainer 椭圆机☐ EN957-1&10:Exercise bicycles with a fixed wheel or without freewheel 健身车 ☐ Pr EN13843: In-Line Skates 轮鞋 ☐ Pr EN13899: Roller Skates 轮鞋 ☐ EN13613 Skateboards 滑板 ☐ EN14619 Scooter 滑板车☐ EN913 Gymnastic equipment 体育器材☐ DIN32935 type A: Tension Training Equipment 拉力器 ☐ DIN32935 type B: Pressure Training Equipment 压力训练器材 ☐ DIN32935 type C: Bending Bar 弯曲棒 ☐ DIN32935 type D: Bending spring 弯曲弹簧 ☐ DIN32935 type E: Finger Bar 手握棒☐ DIN32935 type F: Combined Training Equipment 复合式训练器材 ☐ DIN7920: Skateboard 滑板 ☐ DIN7921: Roller Skates 轮鞋 ☐ DIN32926: Roller Skates 轮鞋☐ ASTM F1250 Stationary Exercise Bicycle 健身车 ☐ ASTM F2264-03: Scooter 滑板车 ☐ ASTM F381 Trampolines 蹦蹦床 ☐ ISO 8098: Children Bike 童车 ☐ AS 4092: Exercise Bike 健身车Other 其他☐ Candle burning test 蜡烛燃烧测试☐ Hardness test 硬度测试☐ BS7272-1 Writing and marking instruments –safety cap ☐ BS7272-2 Writing and marking instruments – end enclosure ☐ EN131 Ladder 梯子☐ ASTM B117 Salt Spray 抗盐雾腐蚀 ___小时 ☐ ASTM D610 Evaluating Rusting Degree 腐蚀评定☐ ISO 4628 Evaluation of degradation of paint coatings 腐蚀评定 ☐ ISO 10289 Corrosion coatings on metal 表层的腐蚀☐ ISO 9227 Salt spray corrosion 抗盐雾腐蚀候___小时☐ Condtioning test: Humidity ___%, Temperature___ºC, ____Hours ☐ Thermol Shock test 高低温冲击测试 ☐ Wood Moisture Content 木材含水量☐ CFR1303 Total Lead 总含铅量☐ ASTM F963 Heavy Metal Test on Coating 涂层的重金属☐ EN71 Part 3 - Toxic Elements Test (8 Toxic elements results) 毒性元素测试 ☐ Total Cadmium (91/338/EEC) 镉含量☐ PVC Plasticzer (EU forbidden 6 phthalates). Sum PVC 中增塑剂（欧盟六种禁用邻苯二甲酸酯类）总量☐ Cleavable Arylamines (Banned Azo Dyes) 可裂解出致癌芳香胺的偶氮染料 (禁用偶氮染料) ☐ PAHs (PAK) 多环芳香烃☐ Cd, Pb,Hg, Cr VI, PBB,PBDE 有害物质测试☐ Wood Formaldehyde Content 木制品的甲醛含量 ☐ PCP Test on Wood 五氯苯酚Remark 注释Other tests were not listed in the table 其他没有列在此表中的项目请详细列出。