Samples Request Form

Be sure to fill in all fields completely.
If you do not wish to have any alternate speeds or packages, put "no alternatives" on the box where it asks for alternative speed and package on the request. (Note: if you do not fill that out, we will automatically upgrade to a higher speed or different temperature).
Please refer to your local Sales Representative for maximum sample order quantities.
Allow 72 hours for processing and shipping. If products requested are not currently available in sample stock your Representative will let you know the shipping schedule.
Orders are shipped Federal Express (2 Day) to your local rep every Tuesday or Thursday.
If you require faster shipment Atmel can charge your shipping carrier (Example: Fed Ex, UPS, or Airborne) account directly. You MUST include a shipping account number and carrier name. Atmel will not "rush ship" without this information.

Fields marked with an asterisk (*) are required

First Name *

Last Name *

Job Title

Job Function

Company *

Address 1 *

Address 2

City *

State/Province (US and Canada only) *

Province (outside US and Canada only) *

Postal Code *

Country *

Telephone *

E-mail Address *

Fax

Products Requested

Part Number *

Quantity *

Alternative Speed or Package *

Part Number

Quantity

Alternative Speed or Package

Part Number

Quantity

Alternative Speed or Package

Application

Telecom

Consumer/Automotive

Computer

Industrial/Military

Network

Other

Potential Production Quantity

Near Term

Long Term

First Buy Date *

Parts per Board *

Urgent Sample Shipping

Carrier Name

Priority Account

Comments or Action