环境可靠性测试申请表-a.docx

环境可靠性测试申请表
Environment Reliability
Testing Application
Sample No.样品编号 : Project No.项目编号:
Applicant:
申请商中文名称:
Address:
申请商中文地址:
Contact Person 联系人:
Telephone 电话:
Fax 传真:
E-mail电邮:
报告中需增 加
Manufacturer 制造商

Supplier 供应商
Same as the applicant name above 同申请商一样
If different from the applicant name above ,indicate as below如果不同，请注明：
Payer付款单位
Invoice Title发票抬头（中文）:
Same as applicant 同申请单位
If different, Indicate as below 如果不同, 请注明:
Sample Name样品名称:
No. of Sample样品数量:
Sample Model样品型号:
Tests Required Please Tick Appropriate Boxes 测试项目(请在 c内打上钩)
气候环境试验Climate Environment Test

高温试验 High temperature test
低温试验 Low temperature test
冷热冲击试验Thermal shock test
快速温变试验 Speedy temperature test
恒温恒湿试验Constant temperature and humidity test
交变湿热试验 Damp heat test
低气压试验 low air pressure test
温湿度循环试验 Temperature/humidity cyclic test

高压蒸煮(PCT) HAST
气体腐蚀 Gas corrosion
UV
太阳辐射Solar radiation
盐雾试验 Salt fog test
IP等级(防尘防水)IP Code
晶须观察 Tin whisker check
臭氧老化 Ozone aging
机械环境试验Mechanical Environment test

振动试验Vibration test
机械冲击试验Mechanical Shock
跌落试验 Drop test
摩擦试验 Abrasion test
HALT & HASS
碰撞试验 Bump test
百格试验Cross-cut tape test
温度/湿度/振动综合试验
Combined Temperature/humidity/vibration test
Other Tests 其它测试:
Test Standard
测试标准：
Test Condition测试条件：
Report Service报告服务 :
Fax 传真 Express Mail 快递到付 EMS 快递，预收费RMB15元 Self Pick-Up 自取
English Report 英文报告 Chinese Report中文报告Chinese & English Report中文、英文报告各一份（需加收RMB100元）
请选择服务类型 Tick the required service：
标准服务 测试完成后3天内出报告 加急服务（加收RMB200/份报告 的服务费） 测试完成后1天出报告
Return Sample:
请您选择测试后样品处理方式，以便项目结束后及时处理 Please tick in below test sample disposal method.
Scrap 报废 Return 寄回(Charge client 客户付费) Picked up by client客户领取（保留3周）
If no indication,the sample will be scrapped after testing如果您不提供样品处理意见，我们将统一报废处理。
We request for the above tests and agree that all testing will be carried out subject to CENTRE TESTING INTERNATIONAL scale of charges as set forth in their latest price list of which we have seen a copy and upon and subject to the terms and conditions set out hereon and overleaf.
Date日期:
Authorized Signature and Chop 代表签名及盖公司章

1. Applicant should retain the Duplicate for own reference and present the same for collection of test report in our office.
2. .No comment may be given for some of the test items if related standard or specification is not available.