Request For Sample (RFS)


WDC offers FREE samples for commercial application in your prototype or existing design. If you are requesting FREE samples for a commercial project please fill out the request for sample form below. Paid samples are available for educational projects and can be ordered using our Order Form.


Please fill out this form completely.
First Name:* MI: Last Name:*
Email:*
Phone Number:*
FAX Number:
Company Name:
Position:
Web Address (URL):
Number of Employees:
 
Ship To:
Address Line 1:*
Address Line 2:
City:*
State:*
Zip:*
Country:*
 
(Samples will be sent US Mail or Airmail if applicable.)
If you wish to ship samples through other means or for faster service please list your FedEx or UPS account number.
 
UPS Account Number
Fed-EX Account Number
Please list if using another form of shipping
 
65xx Device of Interest
Part Number 1:*
Part Number 2:
Are these replacements for Rockwell, CMD, etc?*
Application:*
What development tools do you use?:*
Expected yearly volumes:*
Approximate date of first order:*
 
(*) Required Fields
  
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2166 E. Brown Rd. Mesa, Arizona 85213
phone: 480 962-4545, fax: 480 835-6442

Website produced by The Western Design Center, Inc.
Last updated 6.06.2008
Current date 07.05.2008
Time 02:43 AM