1. Customer Information

• Company/Institution: This is the company or institution where the requestor is affiliated to.   Kindly provide the complete name and avoid abbreviations and acronyms.
• Email,  phone,  address:  These are the contact details of the requestor.  Please supply the email address, contact number and address where the requestor is most readily reachable.
• Requestor: The person who requires/avails the service.  He/she will also be the primary contact person.   The requestor must affix his/her signature in the space provided.
• Sample Brought By: The person who submitted the sample to ADMATEL. He/she must also sign in the designated space.

2. Sample Details

• Quantity: This refers to the number of samples submitted, which may be the total number of all samples or individual quantities per line item.
• Label and Description: Please provide here a label or name for each sample. The sample label/s indicated will be the same label/s that will be used in the analysis report.
• After tests: Please tick according to your preference: sample/s to be disposed or picked up after analysis.
  a. Samples are encouraged to be returned to the respective requestors after analysis.
  b. Samples that are classified as hazardous are automatically tagged for pick-up.  The requestor will be charged with a corresponding disposal fee if he/she refuses or fails to pick- up said samples.
  c. Samples for pick-up are retained only for a maximum of 30 working days after release of results, after which will be processed for due disposal.
• Other materials provided: Please indicate here any additional materials you have submitted aside from the actual sample to be analyzed (e.g. container, glasswares, additional reference samples, etc.).

3. Services Required

• These are the specific test service/s to be availed and the corresponding quantity per test service.   This may be filled with an ADMATEL technical staff.
• Observe during the test:  Please tick if you wish to enter the laboratory to witness the actual conduct of the analysis.  Include the date and time when the observation will take place.

4. Reporting

• Please tick according to your preference:  two methods of reporting, at most.
  a. Interim Report – a preliminary report containing the raw data and other pertinent details of the test but will not be in the official template and is not signed
  b. Certificate of Service Completion – a document which states that the requested analysis is completed. This will be signed by both parties to signify agreement.
  c. Report of Analysis – final report containing the raw data and other pertinent details of the test which is documented in ADMATEL’s official report template and is duly signed by relevant personnel
  Soft Copy — electronic version of the report sent via email or any applicable electronic transfer method
  Hard Copy — the printed version of the report which will be picked up by the requestor at ADMATEL
•  Please tick according to your preference: data obtained from the analyzed sample may or may not be used as ADMATEL marketing materials

5. Remarks

• Please indicate here any other matters of importance that are not reflected in this form.  Additional pages may be added if space is not sufficient.