Pulva Lab Test Form

Pulva Lab Test

General Lab Information

Your Name:

Company Name:

Your Email:

Your Direct Phone Number:

Company Phone Number:

Billing Address:

Billing City:

Billing State:

Billing Zip:

Material Information

Material Information

Name of Material:

Size of Material:

Amount of Material to be Shipped:

Date of Shipment:

Desired fineness of finished product:

Capacity (Pounds per Hour or Gallons per Hour):

Abrasiveness:

Heat Sensitivity:

Moisture or Oil Content:

Additional Information:

IS MATERIAL ANY OF THE FOLLOWING?

Explosive

Poisonous

Noxious

Other

Free Text

Shipping Information

Shipping Information

Due to current regulations concerning the disposal of materials, Pulva Corporation requires that all materials shipped to Pulva for testing purposes MUST be returned to the customer upon completion of the test. All return arrangements must be made prior to the start of any testing.

Please complete the following form and return it to Pulva Corporation along with all other documentation required for testing.

Company:

Attention:

Address:

City:

State:

Zip:

Material Name:

Testing PO Number:

Preferred Shipping Method:

Common Carrier Freight Collect

Customer UPS Account

Customer FEDX Account

Prepay & Invoice (Supply P.O. Number)

Other - (Must be finalized before material is shipped for testing)

Explain...

If using your shipping account #, please provide number:

Authorized Person:

Date:

Submit

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Contact Info

Phone: (800) 878-5828

Address: 105 Industrial Drive, West Valencia, PA 16059

Email: sales@pulva.com