APPLICATION FORM FOR CHEMICAL TESTS

Testing sample submitted by

(company) Supplier grading (mark relevant)
Address Green (category 1)
Telephone Red (category 1 + 2)
Fax
e-mail Service required:
Contact Regular
Cost centre Express
Address 24 hours*

Article number/collection Invoice will be settled by:

Sample description Pay Order No.:
Supplier Date:
Country of origin Bank:
Shipping destination Branch:
* 24 hours: This service is not available for all tests in all laboratories. Please contact your testing institute for details.
INGREDIENT TEST
DESCRIPTION QUALITY NUMBER COLOR(S) COMPOSITION IN %
(for example: shell fabric,
lining, thread…) A B

A All parameters: Azo dyes, Formaldehyde, allergenous disperse dyes and carcinogenic dyes, PCP/TeCP, OPP*,
NP/OP/NPEO/OPEO, chlorinated organic carriers*, Nickel release, Chromium VI, total Cadmium, total lead,
Phthalates, organic tin compounds*, PAH*, PFOS, PFOA*, Dimethylformamide, short-chain chlorinated paraffines
B Parameters related to color: Azo dyes, PCP/TeCP, allergenous disperse dyes and carcinogenic dyes, NP/OP/
NPEO/OPEO, chlorinated organic carriers*, total Cadmium, Chromium VI, total lead
*parameters have to be tested additional from red suppliers (category 1+2)

The supplier will provide laboratories with authorization for Street One
to demand information about current testing status and inspect and
receive copies of testing reports at any time.
Date / signature of ordering party