Company Name
Company Address
Contact Info
Name / Surname
Type of Product Food Medical Product Raw Material Cosmetic Product Packaging Material Polymer Material Pet Food Test Sample Other
Please Define Other Option
Product Name Lot No Quantity Package Type
Of Cartons / Pcs / Kg Cardboard Box Craft / Gunny Bag Aluminum Box Plastic Drum Other
Package Dimension Width (cm) Length (cm) Height (cm)
Total Amount Of Product Total Amount Of Cartons Total Weight (Kg)
Requested Dose Range Min Max
Has Any Irradiation or Chemical Process Ever Been Applied Before? Yes No
Ship Non-Irradiated Products to Gammapak Via Vehicle Belongs to Customer Cargo Carrier
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