Rajawali Lab

RAJAWALI TESTINGLAB
PT. RAJAWALI BASKARA PERKASA
Komplek Rukan Taman Tekno Boulevard Blok A-21
Jl. Raya Taman Tekno Widya, BSD, Tangerang Selatan 15314
Provinsi Banten, Indonesia
Tel. 021-29313344, Fax. 021-29313355

Submission Testing Request Form

Service Level

Regular

Express -- 40% surcharge

Super Express -- 75% surcharge

Note : if the testing is subcontracted to another laboratory, the lead time will be informed separately from the quotation.

APPLICANT'S INFORMATION

Company Name

Contact Person

Telephone

Address

BILLING INFORMATION

Invoice To

The applicant

Others

Company Name

Contact Person

Telephone

Address

Tax No

SAMPLE INFORMATION

Type Sample

For SNI, (based on Sampling doc)

Others

Sample Description

Country of Origin

Brand

Qty Sample

Return Sample

YES

Report

SOFT COPY

HARD COPY

SOFT COPY & HARD COPY

Name

Request Date

We request the above tests and agree to the testing fees and turn around times as set forth in the Rajawali Testing Lab price list, and all services to be performed are subject to the terms and conditions set forth below. We acknowledge that we have fully read, understand, and agree to all of the provisions in the Terms and Conditions set forth below.