Sample Order Form

Please fill out order form: Created on Date: 07/20/2008 Time 03:46:54 AM
Sample Number:	2008-50929

Name:	*
Company:	*
Address:	*

City:	*
State/province:	*
Zip/postal code:	*
Country:	*
Phone Number:	*
Fax Number:
E-mail Address:	*
Ref # or Project Name:
End Customer Market:	*	Automotive Consumer Home Networking Cellular Industrial Power Supply Computer Medical Telecom Consumer Commercial Military/Aerospace
KSE Representatives, KSE Distributors & Contract Manufacturers (Only)
End Customer:	*
End Customer Contact:	*
Contact's Phone #:	*
Ref # or Project Name:	*
* Required Field

Enter full part number from the ordering and specifying information from the data sheets.
Incorrect and/or Non-Valid Part Numbers will automatically be deleted from the sample order.

All samples will be shipped in "Bulk" form and will be processed as "Lead-Free" and will ship via First Class mail. If you require product on tape and reel, quantities greater than 50 pieces, or better shipping method, please contact KOA Speer Customer service @ (814) 362-5536 extension 224.

Item No.	Part Number	Quantity Maximum of 50 pieces
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All samples will ship from the KOA Sales Office that handles your area.

If you have any questions
please call your local sales representative.
or E-mail to:............. KOA Speer Marketing

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