Requisition Form
This form can be used in conjunction with your purchase order for testing at Dirats Laboratories. Please fill it in as completely as possible - the more information you provide us, the more useful your Test Report will be. For your convenience, pop-up dialogue boxes have also been added for online help on each field. Just click on the blue text. When you have completed the form, please print it and send it along with your test material.

Test Material

Requirements

Tests Required
All tests listed in specification tests listed below        Purchase Order #

Return Instructions
Return  
Via  
Account #

Client Information

Contact Person  Please charge this work to this credit card:
Company Name MC___ Visa___ A/E___ Expiration____/____
Address  Card Number:_____________________________________
Exact name as it appears on Credit Card:____________________________
Billing Address for Credit Card:____________________________________
Phone  _____________________________________________
Email  Signature ___________________________

Send to:  Dirats Laboratories    41 Airport Road    Westfield, MA  01085