Your Company:       

Location Address:    

Contact Person:       

Telephone:              

Fax:                        

Email:                     

FACTORY / SUPPLIER INFORMATION:

Name:                    

Inspection Location: 

Contact Person:       

Telephone:              

Fax:                       

Email:                     

PRODUCT / ORDER DETAILS:

Purchase Order:     

Order Details / Description:   

Model:            Quantity:  

Model:           Quantity:  

Model:           Quantity:  

Model:           Quantity:  

Model:           Quantity:  

Reference Samples Available:     Yes No

Special Instructions Available:     Yes No

Latest Date of Shipment:              dd/mm/yyyy

Requested Date of Inspection:     dd/mm/yyyy

Pre-shipment Inspection

During Production Inspection

Online Quality Controll

Child Labour Monitoring

Social Audit

Code of Conduct

Factory Evaluation

Other: