Product and Samples Request
First Name, Initial:
Last Name:
Job Title:
Job Function:
Select...
Project Manager
Engineer
Buyer
Other (Please specify below)
Company:
Street Address:
City:
State or Province:
US Residents: Please use the two-character
abbreviation (e.g. CA) for the name of your state.
Zip or Postal Code:
Country:
Telephone Number:
Fax Number:
Email Address:
Your Project Number:
Program Name:
Type of Request:
Product
Samples
Cap Value:
Voltage:
Dielectric:
*
X7R
BX
N2T
NPO
NPQ
Temperature:
*
125
150
175
200
Higher
Form:
*
Surface Mount Chips:
Epoxy
Solder
NG
Pd
Tin
Sn90
Sn60
Stacks:
N
J
G
Softleads
Radial Leaded:
Is There A Drawing:
Yes
No
Make one for me.
SCD
Spec
Capacitor Part Number:
How Many:
How Soon Are They Needed:
Is partial shipment OK?:
Yes
No
Number needed to get out of trouble.:
Bread board or flight?:
Bread Board
Flight
If we don't have an exact match, may we offer something else?:
*
Higher cap:
Lower cap:
Higher voltage:
Lower voltage:
Different size:
Different lead style:
*
Check all that apply.
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