*Mandatory Field (Must Be Completed Or Sample Will Be Placed on Hold)

*Mandatory Field (Must be completed or sample will be placed on hold)

Submitting For: Nordstrom, Inc. / JDE Number: 50607 / Submitter:
Submitter Contact: / Email Address: / Phone #:
Submitter Address:
Service Requested: (select one) / Regular (4 working days) / Rush+ (3 working days) / Express+ (1 working day)
+Note: Due to product complexity, sample volume or level of testing, expedited service may not be available.
*NPG Contact – Product Developer (Last Name, First Name):
*NPS Number: / Sourcing Category: Choose an item. / If other, please list:
*Division: / Department: (select from the drop-down)
Kids / *NPG Department: / Choose an item. / If other, please list:
*Label Name (E.G. Nordstrom, Halogen, Treasure & Bond, etc.):
*Nordstrom Style (VPN) Number(s): / Retail Style Number(s):
PO Number(s): (If multiple, please list separately)
Ship Date (MM/DD/YY): / *Season: Choose an item. / *Year (YYYY):
*Agent: Choose an item.
Agent Contact Name: / Agent Email Id:
*Manufacturer Name: / *Manufacturer RMS Number:
*Manufacturer Contact Name: / *Manufacturer Email Id:
*Factory Name: / *Factory RMS Number:
*Factory Contact Name: / *Factory Email Id:
*Factory Address: City: State: Country: Postal Code:
Material / Trim Supplier Name: / Material / Trim Supplier Article Number:
*Age Size Range (e.g. 0-2T, 3-4T, etc.): / Snap Button Zipper Supplier:
*Product Description: / *End Use (Dress, Socks, Wallet, etc.):
*Submitted Color(s) / Print Name: / Garment Size Submitted:
Fabric Construction: / Thread / Stitch Count (Stitches per inch):
Fabric Width: / *Garment Weight (Sweater): lbs / dz / Yarn Size: / Gauge:
*Fabric Weight: / (note method of measurement) / g / M2 / oz / yd2 / Momme / g / linear yard
Print /
Dye Type: / Pigment / Sulfur / Indigo / Reactive / Garment / Direct / Disperse / Foil / Piece
Digital / Engineered Print / Yarn dyed / Acid / Heat Transfer/Sublimation / Other:
Finish: / Enzyme Wash / Silicone Wash / Crinkle Wash / Wrinkle Resistant / Garment washed / Softener
Napped/Brushed / Sanded/Sueded/Peached / Bio polished / Compacted/Sanforized / Mercerized
Water Repellent/Resistant / Light/Soft / Medium/Regular / Heavy / Specify wash time:
Flame Retardant / Stain resistant / Soil resistant / Antimicrobial / Reflectivity
UPF / Other:
*Fiber Content Label:
*Care Instruction(s):
*Stage of Testing: / Development / Production

TEST REQUIRED:

PHASE 1
Children’s Fabric & Garment (without trim) Critical Test Package / Children’s Sleepwear Fabric or Seams Critical Test Package
Children’s Fabric & Garment (with trim) Critical Test Package / Children’s Sleepwear Garment Critical Test Package
Children's Socks and Hosiery Critical Test Package / Children's Bedding Critical Test Package
Children’s Accessories Critical Test Package / Swaddle & Receiving Blankets Critical Test Package
Plush Toy & Rattle Critical Test Package / Hooded Towels Critical Test Package
Additional Colors Critical Test Package / Other:
Retest - Previous Report Number:
Additional/Reference Information:
Technique(s) used to improve the failure:
(Mandatory for all retest submissions)
Return Sample: / No / Yes (shipping and handling charges apply)
PHASE 2
TOP garment for CPSIA- Lead in surface coating (if applicable) and lead substrate
Return Sample: / No / Yes (shipping and handling charges apply)
*PRODUCT INFORMATION FOR GCC / CPC:
*Manufacturer Name: / *Country of Origin
(Name of the manufacturer to whom Nordstrom issues the purchase order (P.O.))
*Date of Manufacture: / *Place of Manufacture:
(MM/YYYY) / (City / Province / Country)

BILLING INFORMATION:

Bill to agent, manufacturer or factory only. If Nordstrom is selected, lab will contact submitter for alternate billing party.

Bill to Company: / Contact Person:
Address: / Phone:
E-mail: / Fax:
Date: / Authorized Signature:

FAILURE TO COMPLETE THIS FORM ACCURATELY WILL RESULT IN RETESTING THE ITEM AT MANUFACTURER/VENDOR’S OWN EXPENSE.