深圳市杜因特半导体有限公司

申请人 Applicant *

职务 Position *

客户名称 End Customer Name（终端客户，请填写全称） *

是否已报备 Has it been reported?（没用过我司产品默认选择 '否'） *

样品型号 Sample P/N *

样品数量 Number of Samples/pcs *

产品实际工作电信号输入 Actual working electrical signal input of the product（选填 Don't fill in if you don't know）

是否需要定制丝印？Do you need to customize the icon? *

封装类型或者脚位信息是否能改变？Can the packaging type or pin information be changed? *

月用量 Monthly dosage/kpcs *

应用产品/项目 Application products/Project *

拓扑结构 Topology（选填 Don't fill in if you don't know）

驱动IC型号 Driver IC model（选填 Don't fill in if you don't know）

每板几路 How many routes per board（选填 Don't fill in if you don't know）

竞品 Competition *

收件方式 Receiving Method *

收件信息 Receipt information （需要包含地址、收件人、联系电话，如不祥，我司有权选择不快递 Need to include address, addressee and contact number in case of not detailed, our company has the right to choose not to express）