Sample Request

Customer Information

Country Company Name
Classification Shipping Address

Contact Person's Name Title
Contact Person's Email Cell Phone
Phone No. - - -
Fax No. - -

Sample Request Information
Sample Request InformationProject Information (Pls input at least one record)
Your request date to receive sample
Part No. (Ex: MX29LV800CBGBI-70G) Qty Project NameApplication Flash Supplier for this project_Brand Flash Supplier for this project_Part NoRequest Purpose

Part No. of other supplier (if the other supplier has provided samples, please help us fill out the form.)
SupplierPart No.Qty


Please be reminded that by providing us with personal information, including but not limited to name, birthday, identification number, passport number, fingerprint, marriage status, family information, education, occupation, contact information, financial information, social status, health or medication records, criminal records, and/or other information which may be, directly or indirectly, linked to any individual or his/her identity (individually or collectively “Personal Data”), you will be deemed as having obtained due authorization of disclosure as well as agreed to our collecting, processing and/or use of any or all of such Personal Data and/or its derivatives for purpose of our business activities and/or transaction with you and/or such individual.
Please do not provide any Personal Data or submit the application if you disagree with the above.

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