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GIBRALTAR LABORATORIES,
INC. |
Phone
973.227.6882
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16 Montesano Road
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FAX 973.582-1565 |
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Fairfield, NJ 07004 |
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SAMPLE SUBMISSION FORM |
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P.O. No (Required
for test to be scheduled) _________Quote No: __________Date Sent:_______
Company:________________________________ Address:_________________________________
City, State, Zip:____________________________________________________________________
Phone:_____________Ext. _____ Fax: (Confirmation will be faxed to this #)__________________
Contact: ________________________ E-mail Address: _____________
Authorizing Signature_____________________________ Printed
Name: _______________________
Address Report:_____________________________________________________________________
Address Billing:_____________________________________________________________________
Test Required: ______________________________________________________
Samples submitted for [
] Initial Testing [ ] Retest
Specification: Do you request Gibraltar to initiate an
OOS investigation if out of specification results occur?
Is it to be GLP?* [
] Yes [ ] No RUSH [ ] Yes (+100% Fee)
Test
Article Name: (Use Exact wording desired on final report) _______________________________
________________________________________________________________________________
Lot #: ________________________ Other Identification: __________________
Description: ________________________________________________________________
Comments (Please use space below for further instructions,
additional lot numbers, etc.)
_____________________________________________________GBL
Number: __________
This form completed by: (Name)_______________________ (Title)___________________
GLP Note: GLP studies require three business days for protocol development.
Please contact Quality Assurance (973/227-6882, Ext: 514) for assistance.
Non-GLP studies conform to the same standards as GLP except
for additional administrative and record keeping requirements.
If payment is to be made by Credit Card please go to http://www.gibraltarlabsinc.com/Credit
Card Processing.htm and follow directions.