RoHS/WEEE Request for Quotation Application Form

If you would like to request a quote, please fill out this form as completely as possible. An STR representative will contact you shortly.

Company Information
Company Name:
Address:
 
City:
State / Province:
Zip / Postal Code:
Country:

Contact Information
Name:
Contact Title:
Email:
Telephone:
Fax:

Sample Information
Component     Homogeneous
Sample Description:
Number of Samples Submitted:
Test Individual Materials
Test Combined Materials (maximum of 5 similar materials)

Analysis of Hazardous Substances
(Please check all that apply)
Heavy Metals      Flame Retardants Other Toxic Substances
Lead Polybrominated Biphenyls (PBB) Please Specify Below
Cadmium Polybrominated Diphenyl Ethers (PBDE)
ChromiumVI Halogens (Chlorines and Bromines)
Mercury  
Antimony    
Other Compliance Testing Battery Directive     Packaging Directive
Testing Type XRF Screening     Chemical Analysis

Delivery
Normal     Rush     Other      Special Instructions

 
 
   
 
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