TESTING REQUEST FORM

Please check the appropriate contact below: (MUST CHECK)

LG Sourcing Hong Kong Office
Shirley Tsang - Quality Assurance Manager
T: (852) 2377 1862 F: (852) 2317 0293 / LG Sourcing Shanghai Office
Glen Song – Quality Assurance Manager
T: (86) 21-51164567 F: (86) 21-51164566
ALL COLUMNS MUST BE COMPLETED IN ENGLISH

1. Test Service (Please select)

LGSC-GB-TRFS-GB-LG_SOURCING-V11 Page 1 of 2 Revised: 09/06/2007

Regular Service
Indoor Items – usually 7 working days
Outdoor Items – usually 11 working days
(Consult product testing protocol for exact turn around time) / Rush Service
(5 Working Days with 25% surcharge)
(Contact lab for availability of this service) / Rush Service
(3 Working Days with 40% surcharge)
(Contact lab for availability of this service) / Priority Service
(24 Hours with 100% surcharge)
(Contact lab for availability of this service)

Required Test Information

2. Submission: / Initial Test / Re-Test (Previous US Report# )
(Previous Canada Report# )
*Please fill in the information above if the item has been tested within the last 6 months.
3. Type of Test: / Product Testing / Transit Testing
4. Sample: / Pre-Production Units / Production Units
Customer Complaint (units from Lowe's store) / Customer Complaint (actual customer sample)
5. Invoice
(for billing): / L G Sourcing
(requires LG Sourcing authorized signature) / Vendor Factory
Third Party (please provide company information with contact info. in a separate sheet)
6. Sample Description: ______
7. Vendor Model / Style # (must provide): ______
8. Lowe’s Item# (if available): ______
9. Country of Origin: ______/ 10. Color: ______/ 11. Size: ______
12. Other Specialized Instructions: ______
13. Product Is Intended And Should be Tested For Use (check both boxes if applicable): Indoors Outdoors
14. Product Is Designed And Labeled For Sale In (check both boxes if applicable): United States Canada
15. Component Testing:
(If testing a multiple component product (such as gift pack) and component(s) have been tested within last 6 months, please provide report number for transfer of results to this report.) / Component / Report Number
16. Vendor Information (must provide) /

17. Factory Information (must provide)

Vendor Name: / Factory Name:
Address (in English): / Address (in English):
Address (in Chinese if in China): / Address (in Chinese if in China):
Tel: / Tel:
Fax: / Fax:
Email: / Email:
Contact Person: / Contact Person:
Factory Authorized Signature / Date / Lab #:
Date In:
Date Due: