Complete the form below to request PSL services. Equipment InformationDate MM slash DD slash YYYY Manufacturer Model Number Serial Number DescriptionInstrument ID Number NVLAP Certificate Required Yes No NVLAP Certificate Required PSL will provide time-of-test uncertainty (1) (specify below) PSL will provide interval uncertainty (1) (specify below) Interval Requested (months, year, etc.): As close as possible to Manufacturer’s Recommended Specification (Please supply specifications) ListParameter (2)Range (2) Add RemoveNotes: (1) Final uncertainty and interval (if requested) assigned to equipment will be determined after calibration is complete. (2) Specify parameter, range and uncertainty above or attach previous calibration certificate with information.Special Requirements/Accessories(if this is the first PSL calibration, an instrument manual or calibration procedure should be included) Customer InformationCompany Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Admin ContactName First Last PhoneFax Email Technical ContactName First Last PhoneFax Email Sandia Required Certification Sandia cannot provide services that are available through commercial industry. Prior to accepting the equipment you wish to submit for calibration, Sandia must verify that there is no other source for this calibration. Please complete the following section regarding the reasons for requiring Sandia to perform this effort by checking the appropriate selection:For Technical Consultation requests: SNL is the only source for the level of expertise required to complete this work. (Market search was completed) SNL has in its possession equipment and facilities not available through any other source. (Market search was completed.) For High Precision Calibration: SNL is the only source for the accreditation you require. (Please note required accreditation.) SNL is the only source for a third party, independent calibration. (Only other source located is in direct competition with you.) Unique capabilities (e.g., accuracy requirements, etc.); unable to locate another source. (Market search was completed.) Type of Business Information:Please check the box which reflects the type of business you are: Consortium Under a Large Business Large Business Agency Small Business State/Local Government Entity Institution Consortium, Partnership, or Joint Venture Minority Owned Woman-Owned Business Disadvantaged Business U.S. Federal Government Government Contractor University/Education Lockheed Martin Company Non-Profit Organization Other If other, what type of company? Is your company U.S. owned and controlled? Yes No If no, which country? Has your company been suspended or debarred from doing business with a Federal Agency? Yes No CAPTCHAEmailThis field is for validation purposes and should be left unchanged.