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southern california
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email:
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phone: 1-877-570-4880
fax: 1-877-570-4700
location:
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product line
Astec - Registration Form
*
- required fields
Distributor & Contact Information
*
Distributor:
All American
All American (Mexico Division)
Arrow
Digi-Key
FAI
Future
Newark In One
Norvell Electronics
Sager
(Direct)
Nu Horizons
*
Name:
*
Phone:
*
Email:
Customer Contact Information
*
Customer Name ::
Email:
*
Address ::
Address ::
*
City ::
*
Zip ::
*
State ::
*
Phone:
*
Buyer / Engineer Name ::
Program Information
*
Program Name :
*
Application ::
Automotive
Bill Board
Burn In
Cash Register / POS
Computer - Notebook
Computer - Desktop
Copier
Gaming
IC Fab Equip
In-Flight Ent.
Medical
Military / Aerospace
Mobile Phones
Monitors
Motor Control
Network
Security
Other (explain in comments)
*
Evaluation Required Date :
*
Program Production Date :
*
Program Life (in years):
*
CM:
Part Number (1) & Pricing
(Competition data required for Special Pricing, otherwise list as "n/a")
*
Astec P/N (1) :
*
Target Selling Price :
*
Target Cost :
*
Competition:
*
Competition Part Number:
Part Number (2) & Pricing
(Competition data required for Special Pricing, otherwise list as "n/a")
Astec P/N (2) :
Target Selling Price :
Target Cost :
Competition:
Competition Part Number:
Part Number (3) & Pricing
(Competition data required for Special Pricing, otherwise list as "n/a")
Astec P/N (3) :
Target Selling Price :
Target Cost :
Competition:
Competition Part Number:
Qty Information
*
1st Year Qty :
*
2nd Year Qty :
*
3rd Year Qty :
Comments
Notes / Comments :
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