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