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Home
New Sample Request Form
()
Request Forms
Split Commission List
New Sample Request Form
Status: Pending
Sample Request #:
Name
Email
Company
Date
Customer
Company
*
Contact
*
Title
Phone
Email
*
Address
Sales Representative
Company
Contact
Title
Phone
Email
Address
Distribuitor
Company
Select
AERO-SPACE SOUTHWEST, INC
ALLIED ELECTRONICS
AVNET INC
BEYOND COMPONENTS
BISCO INDUSTRIES, INC.
BRAVO ELECTRO COMPONENTS
CARLTON-BATES COMPANY
DIGI-KEY ELECTRONICS
FUTURE ELECTRONICS
GO ELECTRONICS
HARDWARE SPECIALTY CO.
MASTER ELECTRONICS
MOUSER ELECTRONICS
SAGER ELECTRONICS
SIMCONA ELECTRONICS CORP.
WES-GARDE COMP. GROUP
Contact
Title
Phone
Email
Address
Qty (pcs.)
*
Part Number
*
Description
Comments
Shipping & Billing
Required Date
*
Ship Via
Recipient's Name
Ship to Company
Ship to Address
Recipients Phone number
Shipping Service
Fedex
Others
Billing instruction
Sender
Recipient
Third Party
Another information
Account Number
Other Notes
1. Project Name:
*
2. Product in which the fan will be installed:
*
3. Application Code:
*
Select
CA01 - Car Infotainment / Navigator
CA02 - Car Seat Ventilation
CA03 - Car Battery Pack & DCDC Convertor
CA04 - Car A/C Sensor
CA05 - Car Dashboard / Display / Cluster
CA08 - Car LED lamp
CA09 - HVAC BLDC Motor
CA11 - ADAS System
CA12 - Cup Holder
CA13 - Wireless Charger
CA14 - PM2.5/Air Purifer
CA99 - Other Vehicle Electric Application
CP01 - DT CPU Cooler
CP02 - VGA/Image Chip Cooler
CP04 - DT Power Supply
CP05 - NB/Net book
CP06 - DT System
CP18 - AIO PC System
CP19 - AIO PC Power Supply
CP20 - Ultrabook
CP21 - Tablet PC
CP23 - Gaming DT case
CP24 - Gaming DT CPU cooler
CP25 - Gaming DT Power supply
CP26 - Gaming DT related products or accessories
CP27 - Mining Machines
CP99 - Other Computer Application
CS02 - Game Console
CS03 - Set Top Box
CS07 - Audio Equipment
CS10 - White goods (Refrigerator)
CS11 - White goods (washing machine , Dryer)
CS15 - Ventilating Fan
CS16 - Water Heaters
CS17 - Washlet/ Electronic bidet
CS18 - Table-top Air Purifier
CS19 - Ceiling Fan Motor
CS20 - Large Size Air Purifier
CS21 - White goods (Dish washer)
CS22 - White goods (Induction cooking)
CS23 - White goods (Oven)
CS24 - White goods (Air conditioner)
CS25 - Smart TV
CS26 - Sound bar
CS27 - Hair dryer
CS28 - Range Hood
CS29 - Household/Service Robots
CS99 - Other Home Application
CT01 - Networking (router, switch, hub)
CT02 - Telecom
CT03 - Server Power Supply
CT04 - Server System
CT05 - Workstation power supply
CT06 - Workstation system
CT07 - Storage, RAID
CT08 - Network Attached Storage,NAS
CT10 - Home Networking Gateway, Router
DT99 - Trader/ Distributer
HD01 - Smart Helmet
HD02 - VR Gear & AR Gear
HV01 - Air to Air Energy Recovery Ventilation
HV02 - residential or commercial gas furnance
HV03 - commercial walk in refrigeration
HV04 - controller or datacom cooling
HV05 - forced circulation air-colling and air-heating coils
HV06 - transport refrigeration
HV07 - condenser unit
HV08 - evaporator unit
HV09 - water chilling packages
IE01 - Machine Tool / Machinery Equipment/Industry Equipment
IE02 - Commercial Freezer (showcase, vending machine)
IE04 - Medical & Healthcare Instrument and Equipment
IE09 - Industrial Inverter
IE10 - Industry PC
IE11 - Surveillance System
IE12 - PV / CPV Inverter
IE13 - Robots
IE14 - Industrial Drive
IE16 - UPS
IE17 - Charging Station
IE19 - Drone -- Fan (Not MMF fan)
IE20 - Drone -- Motor
IE21 - Drone -- Propeller
IE22 - Drone -- Fan(Mini Fan)
IE23 - Smart mask
IE24 - Air-conditioning and Refrigeration Products_Big Axail Fan & Centrifugal fan Blower
IE25 - Air Curtain/Air Door Application_Centrifugal Fan Blower & Axail Fan &
IE26 - Industry 4.0_Automated Guided Vehicle / Automatic Guided Vehicle (AGV)_Motor System
IE27 - Industry 4.0_Conveyor Rollers
IE28 - large area industrial / commercial / agriculture / husbandry ceiling fan
IE33 - Energy storage systems (Household)
IE99 - Other Industry
LE08 - Par Light
LE09 - Corn Light
LE10 - Stage Light/ Photography Light
LE11 - Commercial Lighting (Spotlight/Downlight/Track Light/ Ceiling Light)
LE12 - Industrial Lighting(High Bay Light/Canopy Light/Street Light/Parking lot Light/Flood Light/Wall pack Light)
LE13 - Special Lighting(Grow Light/Aquarium Light/Garden Light)
LE99 - Other LED Lighting
MD01 - Smart Phone
MD02 - Mobile Device Cooling Case
MD03 - Mobile Air Detector
MD99 - Other Mobile Device
MG01 - mogear cooling case
OE01 - Projector/Pico Projector/Mini Projector
OE02 - Copy Machine/Print/Multi Print
OE03 - Projector (Water pump)
4. Estimated Annual Quantity (psc.):
5. Comments / Special Requirements:
6. Sales Order Number:
7. Tracking Number:
8. CRM Opportunity ID:
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