QTP Form

Microcontroller & Digital Signal Controller QTP/SQTP ORDER FORM

Microchip Technology Inc., 2355 West Chandler Blvd., Chandler, Arizona, 85224-6199 USA. Phone: 1-800-437-2767
All Boxes On This Form Must Be Completed, Otherwise No Action Will Be Taken Note:  denotes required fields.

Email Address:
Company/University
Address(City, State, Zip, Country):
Registered User:
Special Instructions:
End Customer Name:

Shipping Information:

Ship To:
Company/University
Shipping Address:
Phone (helps with shipment tracking) #:

Are you working with Microchip Sales Person?


Application Information:
Device Selection Note: All Packages are Pb-free

Program Name:
Device:
Package:
Your Part Number (Optional):

1) Does this device require special testing similar to an existing Microchip device?
If yes, enter existing part number:
2) Has Microchip previously approved a device specification for this product?
If yes, advise your specification or NSCAR number:


Serialization:
Serialization Type:
Start Address:
Number of Addresses:
Start Number(Seq. Only):
Increment(Seq. Only):
Stop Number(if required, optional):
Seed(Psuedo Only):
Serial Number Memory Location:

Part Marking:
1st Line:
2nd Line:
3rd Line:
4th Line:
5th Line:
6th Line:
7th Line:

YY=Year, WW=Week, NNN=Lot Tracking Number:


ID Memory:
Checksum:
MPLAB version:


Version:1
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