Rubber Insulating Products /Testing Order Form

Rubber Insulating Products /Testing Order Form

AC testing in accordance with applicable ASTM Specifications and Test Methods
Company Name
Billing Street Address or PO Box
Billing City
Billing State
Billing ZIP
Ship To Company Name
Shipping Street Address
Shipping City
Shipping State
Shipping ZIP
Phone Number

Area CodePhone Number
Email
example@example.com
Contact Full Name

First NameLast Name
Purchase Order No.
How are you sending your goods to us?
Date you are shipping to us
Carrier used to ship to us
Carrier tracking number

Please advise the quantity of PAIRS of rubber insulating gloves that you are returning for test (combine all lengths and colors)

Rows	size 7	size 8	size 8 1/2	size 9	size 9 1/2	size 10	size 10 1/2	size 11	size 12	size 13
class 00
class 0
class 1
class 2
class 3
class 4

Please advise the quantity of PAIRS of rubber insulating sleeves that you are returning for test (combine all colors and shapes)

Rows	Size Small	Size Regular	Size Large	Size XL	Size 2XL
Class 1
Class 2
Class 3
Class 4

Please advise the quantity of rubber insulating blankets that you are returning for test (all colors and solid+slotted)

Rows	Size 18x36	Size 22x22	Size 27x36	Size 36x36	Other Sizes
Class 0
Class 2
Class 4

Please advise the quantity of other products (i.e. hot sticks, line hose, jumper cables, temporary grounding cables, etc.) that you are returning for test.
Quantity & Description
Quantity & Description
Quantity & Description
All processing will be in accordance with ASTM specified procedures, including
1. Check-in and received quantity verification
2. Removing old marking and complete cleaning
3. Complete visual inspection (inner & outer, top & bottom surfaces)
4. Dielectric test (A/C) at the rated proof test voltage for 1 minute
5. Marking of all products per ASTM standard and customer requirements (see below)
6. Prepare return shipment (with or without failed goods - see below)
Ship products for testing, including a printed copy of this form, to:

Saf-T-Gard International
Voltgard Test Lab
205 Huehl Road
Northbrook IL 60062

Estimated turn-around time is 8-10 working days.

RUSH SERVICE (48-72 hours) may be available for rubber gloves, sleeves and blankets only.
PLEASE CALL AHEAD TO PRE-ALERT OUR TEAM TO YOUR RUSH ORDER AND HAVE YOUR SHIPMENT TRACKING NUMBER AVAILABLE.
- RUSH SERVICE for gloves. Additional $10.00 per pair (less than 10 pairs)
- RUSH SERVICE for gloves. Additional $5.00 per pair (10-50 pairs
  No RUSH available for more than 50 pairs)
- RUSH SERVICE for sleeves. Additional $26.00 per pair (less than 10 pairs)
- RUSH SERVICE for sleeves. Additional $13.00 per pair (10-50 pairs
  No RUSH available for more than 50 pairs)
- RUSH SERVICE for blankets. Additional $20.00 each (less than 10 blankets)
- RUSH SERVICE for blankets. Additional $10.00 each (10-50 blankets
  No RUSH available for more than 50 blankets)
All orders FOB Northbrook IL.
Minumum order $50. Orders less than $50 may be subject to a $5 handling fee.

ASTM MARKING REQUIREMENTS

ASTM standards for maximum retest intervals are:
- Gloves - 6 months
- Sleeves and blankets - 12 months
- Line hose - prior to use or reissue
- Rubber insulating products shall not be put into service unless they have been electrically tested within prior 12 months
We recommend that your rubber goods are marked both with Date of Test and Date of Return for Test. This is our default marking unless you advise us below of your instructions.
If you want your RETURN FOR TEST date to be shorter than the ASTM standard, please indicate here
How would you like us to handle any products that fail inspection or testing?
SPECIAL REQUESTS OR NOTES APPLICABLE TO YOUR TESTING ORDER
Please PRINT this form in 2 copies, one for your records and one to include with your shipment. Then SUBMIT.
Should be Empty: