Testing Request Form

WHOLESALER REQUEST FORM

The Residue and Microbial Test Program
for Australia’s Fresh Produce Industry

Date:

TESTING REQUEST FORM

SAMPLE 1
Grower Name
Address
Product Type / Variety
Test Code / C3 C4 C5 C6 / Batch
Test Code / HM1 HM2 HM3 HM6 HM10 / Batch
Test Code / M1 M2 M3 M2C M3 M5 M9 M11 / Batch
Comments
Do you give Palmer Produce Management permission to save these results on their supplier database? / Signature
SAMPLE 2
Grower Name
Address
Product Type / Variety
Test Code / C3 C4 C5 C6 / Batch
Test Code / HM1 HM2 HM3 HM6 HM10 / Batch
Test Code / M1 M2 M3 M2C M3 M5 M9 M11 / Batch
Comments
Do you give Palmer Produce Management permission to save these results on their supplier database? / Signature
SAMPLE 3
Grower Name
Address
Product Type / Variety
Test Code / C3 C4 C5 C6 / Batch
Test Code / HM1 HM2 HM3 HM6 HM10 / Batch
Test Code / M1 M2 M3 M2C M3 M5 M9 M11 / Batch
Comments
Do you give Palmer Produce Management permission to save these results on their supplier database? / Signature
SAMPLE 4
Grower Name
Address
Product Type / Variety
Test Code / C3 C4 C5 C6 / Batch
Test Code / HM1 HM2 HM3 HM6 HM10 / Batch
Test Code / M1 M2 M3 M2C M3 M5 M9 M11 / Batch
Comments
Do you give Palmer Produce Management permission to save these results on their supplier database? / Signature
SAMPLE 5
Grower Name
Address
Product Type / Variety
Test Code / C3 C4 C5 C6 / Batch
Test Code / HM1 HM2 HM3 HM6 HM10 / Batch
Test Code / M1 M2 M3 M2C M3 M5 M9 M11 / Batch
Comments
Do you give Palmer Produce Management permission to save these results on their supplier database? / Signature
SAMPLE 6
Grower Name
Address
Product Type / Variety
Test Code / C3 C4 C5 C6 / Batch
Test Code / HM1 HM2 HM3 HM6 HM10 / Batch
Test Code / M1 M2 M3 M2C M3 M5 M9 M11 / Batch
Comments
Do you give Palmer Produce Management permission to save these results on their supplier database? / Signature
SAMPLE 7
Grower Name
Address
Product Type / Variety
Test Code / C3 C4 C5 C6 / Batch
Test Code / HM1 HM2 HM3 HM6 HM10 / Batch
Test Code / M1 M2 M3 M2C M3 M5 M9 M11 / Batch
Comments
Do you give Palmer Produce Management permission to save these results on their supplier database? / Signature
SAMPLE 8
Grower Name
Address
Product Type / Variety
Test Code / C3 C4 C5 C6 / Batch
Test Code / HM1 HM2 HM3 HM6 HM10 / Batch
Test Code / M1 M2 M3 M2C M3 M5 M9 M11 / Batch
Comments
Do you give Palmer Produce Management permission to save these results on their supplier database? / Signature
SAMPLE 9
Grower Name
Address
Product Type / Variety
Test Code / C3 C4 C5 C6 / Batch
Test Code / HM1 HM2 HM3 HM6 HM10 / Batch
Test Code / M1 M2 M3 M2C M3 M5 M9 M11 / Batch
Comments
Do you give Palmer Produce Management permission to save these results on their supplier database? / Signature
SAMPLE 10
Grower Name
Address
Product Type / Variety
Test Code / C3 C4 C5 C6 / Batch
Test Code / HM1 HM2 HM3 HM6 HM10 / Batch
Test Code / M1 M2 M3 M2C M3 M5 M9 M11 / Batch
Comments
Do you give Palmer Produce Management permission to save these results on their supplier database? / Signature

Fax to Palmer Produce Management on (08) 8260 7789 two days prior to collection day– 12/12/14