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State / Province
Postal / Zip Code
Point of Contact:
Type of Test:
Number of Unit:
Size (L x W x H):
List Tests and Applicable Specifications Here (ie. Shock Test per Mil-Std-810C, Method 516, Procedure I)
If Shock or Vibration Testing is required, do you have a fixture for mounting the test items to the test equipment?:
If YES, please provide the fixture's mounting hole pattern.
Is a Test Report Required?
Is a Certificate of Compliance Required?
Do you want Raw Test Data Only?
Approximate Timeframe that you would like to start testing:
Other questions and addition information:
Should be Empty: