Please submit samples to:
C.G. LABORATORIES, INC.
Attn: Laboratory, 1410 Southtown Drive Granbury, Texas 76048
Phone: 817-279-1945 l Fax: 817-573-3304
Where Service and Guidance Never Stop
82070-592, Rev. C
Aging Study / Stability Study Test Request Form
Reporting Information
Billing Information
Company
Contact
Address
City
Zip Code
Phone No.
Company
Contact
Address
City
Zip Code
Phone No.
State
Country
(Same as Reporting)
State
Country
PO No.
Email
Quote No
WILL BE INCLUDED
ON INVOICE
Reporting
Unless specified, all reports will be emailed and mailed. Request for additional copies of reports will be honored. Charges will be invoiced accordingly.
Mail and Email Results
Mail Results ONLY
Email Results ONLY
Test Code
AGS-001
AGS-002
AGS-003
AGS-004
AGS-005
Test Code
Aging Study Requested
Temperature
Humidity
Room Temperature Aging
Accelerated Aging
Accelerated Aging
Accelerated Aging
Special Parameters (42C – 68C max, max. 4 cu. foot)
25°C (+/- 2°C)
40°C (+/- 2°C)
55°C (+/- 2°C)
55°C (+/- 2°C)
°C
60% RH (+/- 5% RH)
75% RH (+/- 5% RH)
60% RH (+/- 5% RH)
NA
NA
Sample Identification
Lot Number
Included in Final Report
Included in Final Report
Requested Pull Points:
Total No. of samples sent
Included in Final Report
Pull Point Information:
Once Aging Study is complete, all remaining samples will be returned to the address listed below. Handling fee will be applied to invoice.
No. of samples to pull at each
Pull Point:
NA
(excluding weight loss samples, when applicable)
No. of samples to send back to
Customer at each Pull Point:
NA
No. of samples for Weight
Loss Testing
No. of samples for testing at
CG Labs, per Pull Point: (See
NA
NA
Separate TRF)
Shipping Instructions
This section requires completion for all Customers. Freight charges will be billed directly to account number listed below. If account number is not provided, freight charges will be billed to CGL
Freight Account, and “Shipping Fee” will be applied to invoice, along with the actual freight charges.
Bill all freight charges to CGL Freight Account
Company:
Attn:
Address:
City:
Customer Freight
Account Number:
Shipping Method
(Overnight, 2nd Day, etc):
State:
Zip Code:
Declared Value:
(amount for return shipment)
Unless specified, samples will be shipped Overnight.
Comments / Special Instructions:
Customer Signature
Date:
CG LABS USE ONLY
Reference Number
Product Rcvd Date /
Time:
TRF Received Date
Product in Incubator
Date / Time
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