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Seating Specimen
Description |
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Please complete one form for every specimen presented |
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Today's Date:. _________________ Please type or print clearly |
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Please print this form from your browser, fill it out, then fax to (616)532-0447, or send with sample |
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| Company
Name & Address: _____________________________________ _____________________________________ _____________________________________ _____________________________________ |
Contact
Person: |
| Bill
To Address:
Same as above
_____________________________________ _____________________________________ _____________________________________ _____________________________________ |
Mailing
Address for Report: |
| Video Required: No Yes |
Return Sample: No Yes |
| Purchase
Order #: |
Who will
Witness? |
| Specimen Information Required | |
| Product Name: |
Model #: |
| Fabric
Description (with percent composition and weight): |
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| Interliner/Blocking
Layer Description: |
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| Fill
Description, with order of layering (thicknesses of layers): |
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| Shape/Style: |
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| Sample
Weight: |
Weight of Frame: |
| Weight
of Combustibles: |
Dimensions of Seat Cushions: |
| Distance
of Gap Between Seat/Back: |
Dimension of Arms: |
| Dimension of
Back Cushions: |
Reason for
Specimen Testing: |
| All furniture
submitted for testing should contain proper Law and Flammability
Labels Caution: The performance of the submitted sample is not necessarily an accurate indication of the performance of furniture in a real-life fire situation |
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TouchStone Systems &
Services, Inc. |
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