Date :

Please fill out the required fields marked with *,and provide as much information as possible. Thanks

1. End Customer Information

Company Name*
Address*
Website*
Contact*		Job Title *
Phone*		Email*
Business Type*	Distributor Manufacturer Contract Manufacturer End User

2. Project Information

Project*	On Going Project	On Going Project-Exsiting Brand & P/N *
	New Project One-Time Buying Other
Application*
Product description & additional features*
Estimated Usage Quantity*		Target Price & Shipments Schedules (if multiple partial shipments required)*