Material Compliance Declaration Form

Company Name

Contact Person Name

First NameLast Name

Contact Email Address

example@example.com

Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Company Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Product or Material Name

Product or Material Part Number/ID

Material Composition (List all major materials and their percentages)

Which compliance standards does this product/material meet?

Other

Does this product/material contain any of the following restricted substances above allowable thresholds?

Upload supporting compliance documents (e.g., test reports, certificates)

Authorized Representative Signature

Date of Declaration

Date