Memory Solutions (Flash, DDR Memory, DRAM)

MANUFACTURER:

UNIGEN CORPORATION

REGISTRATION NUMBER

Distributor/Sales Rep:
	Location:		Demand Creation Protection #

FAE:		Phone:		Ext.:
Sales Person:		Phone:		Mobile:

CUSTOMER INFORMATION:

Distributor Account Number:

Mfg. Salesperson:

Phone:

Customer Account Number

Mfg. FAE:

Phone:

PROJECT INFORMATION:

Status:

Prototype Date:

Project Name:		Units:		Production Date:
			Quantity		Expected or Actual

Description:
(Application)

Project Engineer:

Phone:

Ext.:

Additional Engineer:		Phone:		Ext.:
Purchasing Contact:		Phone:		Ext.:

PART NUMBER FOR REGISTRATION	Joint Visit Date:
R = Registerable A = Associated

Distributor's e-mail address	Rep	Rep's e-mail address	Unigen's CSM's e-mail address

Electronically signed by:

Distributor	Sales Rep	Unigen's CSM