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1、Official Use Only(CTI 内部填写)Name(跟单人姓名)：Rec. Date(收样日期)：Out Date(出单日期)：Order No. (报告编号)：Amount of Sample(样品量)：Form No.：Footwear Testing Application Form鞋类测试申请表Please fill in the application form and make sure you have involved all terms marked by请务必完整填写带的项目One application Match to one test report 一份申
2、请表对应一份报告Company Name & Address Shown on Test Report 报告抬头之公司名称及地址ApplicantName申请公司名称 中/英文：Address地址 中/英文：Contact Person联系人：Email邮箱：Telephone 电话：Fax传真：Payer Name付款公司名称/发票抬头:Address 地址：Contact Person联系人：Email邮箱：Telephone 电话：Fax传真：Report Delivered to (报告送达)Applicant申请方Payer付款方Invoice Delivered to(发票送达)A
3、pplicant申请方Payer付款方Samle Description样品描述Sample name样品名称：Style No.款号：Materialcomposition成分：P.O. No./Order No.订单号：Sample Color颜色：Buyer买家：Amount of sample样品量：Supplier供应商：Label商标名称：Country of Origin来源地：End uses最终用途：Country of Destination目的地：Test Required 测试项目：Shoe成品鞋：Sole Bonding Strength鞋底黏着力Flex曲折Heel
4、 Attachment鞋跟拉力Aging老化Anti-yellowing耐黄变Pull Strength for Strap/Ornament带子/饰物拉脱Waterproof静态 /动态防水Safety Toe Impact钢头冲击SafetyToe Compression钢头压缩Nail Penetration钢中底耐穿刺Electric Shock Resistance电击Electric Resistance抗静电Phenolic Yellowing酚黄Upper鞋面：Burst爆破Tear撕裂Tensile Strength抗拉Flex曲折Abrasion耐磨Anti-yellowi
5、ng耐黄变Colorfastness to Crocking摩擦褪色Colorfastness to Water耐水色牢度Outsole大底：Hardness硬度Density密度Flex曲折Oil Resistance耐油Tear撕裂Tensile拉伸Non-marking不留痕Slip Resistance防滑Blooming吐霜Anti-yellowing耐黄变Hydrolysis耐水解Abrasion耐磨Insole中底：Transfer Tensile Strength 平面抗拉Abrasion耐磨Flex(Ross)曲折Flex(SATRA PM3)曲折其他Others:Lace鞋
6、带：Tensile拉力Abrasion耐磨Metallic Buckle金属扣：Corrosion腐蚀性Heel鞋跟:Impact冲击Fatigue Resistance抗疲劳Toplift天皮:耐磨AbrasionZipper拉链:Puller Attachment拉头拉力Top and Bottom Stop Attachment止滑扣结合力Breaking Strength of Chain链齿咬合强度Slider Locking闭锁强度Torque Test扭力测试Gore松紧带：Tensile延伸力Repeated Extension抗疲劳Chemical (化学)Azo Dyes
7、偶氮染料Formaldehyde Content甲醛pH Value酸碱值Extractable Heavy Metals可萃取重金属Allergenous Dyes 分散性染料Carcinogenic Dyes 致癌染料Total Lead Content 总铅含量Total Cadmium Content总镉含量Phthalates 邻苯二甲酸盐PCP/TeCP/TriCP五/四/三氯苯酚OPP 邻苯基苯酚Pesticide 杀虫剂Chromium (VI)六价铬Nickel Release 镍释放量TBT/DBT/MBT三/二/单丁基锡APEOs烷基酚聚氧乙烯醚PAHs多环芳烃PFOS/
8、PFOS全氟辛烷磺酸盐/全氟辛酸DMF富马酸二甲酯PCBs多氯联苯PCTs多氯三联苯Flame retardant阻燃剂Choro organic carriers有机氯载体ODS , ozone depleting substances全氯氟烃VOCs 挥发性有机化合物PVC 聚氯乙稀VCM氯乙稀单体BHT抗氧化剂Bisphenol-A双酚AOthers 其它项目：Standard Test Method 采用标准：ISO(International/Europe 国际/欧洲)ASTM/AATCC/CPSC/CPSIA(U.S.A 美国)BS(Britain 英国) DIN(Germany德
9、国)GB(China中国) Others/其它：Service Required：(注:常规有机项目只有常规和加急服务，加急服务加收100%附加费)Regular ( 5 working days ) 常规5个工作日Express (3 working days) 加急 3个工作日(40Surcharge) Shuttle (1.5 working days) 特快1.5个工作日 (100Surcharge ) Same Day(1 working days)当天( 150Surcharge )Report language 报告文种: Chinese 中文 English 英文（RMB100
10、 added for bilingual formal report中英文双语报告加收人民币100元）Test Type 测试类型： First Test 首测 Retest 重测 (PreviousReportNo.原报告号)Comment on test results 报告上显示评语： Yes 是 No 否 Return sample 退样品 ： No 不需要 Remained测试后剩余样品 Tested测试样板 All全部Report Service报告送达方式： Fax传真 Email 邮件 Express 特快专递 Self pick-up 自取The above services are bound to General Conditions of Service以上测试服务均受服务通用条款约The minimum consumption should be RMB100 per report.The charge of report revision will be RMB100 per report.单笔报告最低消费100元,报告更改费100元/每份以上申请是否涉及法律纠纷，如果有，请说明Authorized Signature Company Chop申请人盖章及签名：Date日期：1 / 1
