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Project Information

Opportunity/Reference code

Program Name *

Target Application *

Target End Product *

Product Family *

Distributor

Is the product destined for a semiconductor fabrication facility in China for development or production of Integrated Circuits? *

Will the product be used for development or production of equipment that will be used for the manufacture, test, or inspection of semiconductors in China? *

Comments

Selected Products

Customer Information

Customer First Name *

Customer Last Name*

Customer Email *

Customer Phone *

End Customer Company Name *

Customer Country *

Company Region *

Customer Street Address *

Customer City *

Customer State *

Customer Zip Code *

Customer Company Website

Enter valid URL with "http://". If you don't have a website, enter "N/A".

Billing Information

This address/Name is to be used solely for the purpose of generating zero- amount invoices.

Same as Customer Information

Billing Company Name *

Billing Country *

Billing Street Address *

Billing City *

Billing State *

Billing Zip Code *

Shipping Information

Same as End Customer Information

Same as Billing Information

Shipping Company Name *

Shipping Country *

Shipping Street Address *

Shipping City *

Shipping State *

Shipping Zip Code *

Recipient's Contact Information

Recipient's First Name *

Recipient's Last Name*

Recipient's Email *

Recipient's Company Name *

Recipient's Phone

Requestor's Contact Information

Same as Recipient Contact Information

Requestor's First Name *

Requestor's Last Name*

Requestor's Email *

Requestor's Company Name *

Requestor's Phone

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