Your PTP account #:

2019 Proficiency Testing Program for

Chemical Analysis – Carbon Steel and Stainless Steel

Chemical Analysis of Plain Carbon & Low Alloy Steel:

 Four quarters (February/May/August/November) - $890.00 (PTPCS2019)
 First and Third Quarters (February/August) - $556.00 (PTPCS132019)
 Second and Fourth Quarters (May/November) - $556.00 (PTPCS242019)

 Chemical Analysis of Stainless Steel (April/October) - $574.00 (PTPSS2019)

BILL TO ADDRESS: SHIP TO ADDRESS:

Name ________________________________________ Name ________________________________________

Company _____________________________________
Address ______________________________________
_____________________________________________
City _____________________ State ____ Zip _______
Country ______________________________________
Phone (____)__________________________________
E-mail _______________________________________
Company _____________________________________
Address ______________________________________
_____________________________________________
City _____________________ State ____ Zip _______
Country ______________________________________
Phone (____)__________________________________
E-mail _______________________________________

IMPORTANT: Non-continental U.S. participants have the following options for shipment of samples:

Provide complete mailing address of U.S. Shipping Agent OR
Name:______________________________________
Company:___________________________________
___________________________________________
City________________ State______ Zip__________
Phone:_________________________________
E-mail:_________________________________
Provide Direct Shipping Information
___FedEx ___DHL ___UPS
Account #________________________
If using DHL, a DHL import account
number is necessary. This account
number will usually begin with a 9.

METHOD OF PAYMENT
Add applicable sales tax to the net value of your order

 Purchase order enclosed  ELECTRONIC FUND TRANSFERS (EFT) to:

BB&T; 2501 Wooten Blvd. SW
 Check or money order enclosed. Wilson, NC 27893
Make payable in U.S. Dollar (on a U.S. Bank) to: Account Number 1390004241750
ASTM International – PTP Routing Number 031309123
Swift Code: BRBTUS33
(Identify payments as “ASTM-PTP” along with your name and company.)
 Credit Card  AMEX  MasterCard  VISA
If paying by purchase order or wire transfer, please
Account Number ________________________________
e-mail this registration form to ptp@astm.org
Exp. Date ___________ Security Code_______________

Print Name: ______________________________________

If paying by credit card, please fax this
registration form to 610-834-7042