UPT | Utility Product Testing

Prefer to mail in your intake form?

If you would like to mail in an intake form rather than fill out the form below please download this fillable PDF and include a printed copy of it with your order shipment.

Purchase Info

Business Name

Purchase Order Number

Billing Info

First Name

Last Name

Email Address

Phone Number

Ext

Fax Number

Address

Address Line 2

City

State

Zip Code

Shipping Info

First Name

Last Name

Email Address

Phone Number

Ext

Fax Number

Address

Address Line 2

City

State

Zip Code

Order Info

Please note any critical information that must remain on gloves

Should your items fail, would you like replacements automatically shipped to you using the same purchase number?

Yes No Call Me

Gloves

Please indicate the quantity of gloves you are returning for testing

Class	Size
	7	8	9	10	11	12
00
0
1
2
3
4

Sleeves

Please indicate the quantity of sleeves you are returning for testing

Class	Size
	S	R	L	XL
00
0
1
2
3
4

Blankets

Please indicate the quantity of blankets you are returning for testing

Class	Quantity	Style	Size	Color
0
2
3
4

Call Today: 480-264-3452

Intake Form

Prefer to mail in your intake form?

Purchase Info

Billing Info

Shipping Info

Order Info

Gloves

Sleeves

Blankets

Prefer to mail in your intake form?

Purchase Info

Billing Info

Shipping Info Same as Billing

Order Info

Gloves

Sleeves

Blankets

Shipping Info