QUALIFICATION REQUEST FORM
1516 Montague Expressway, San Jose -  CA 95131
Tel: (408) 955-9505 Fax: (408) 955-9599
Technical Sales: sales@icenginc.com General Information: info@icenginc.com
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* Company:
* Contact name:
* Telephone:
* Fax:
P.O. Number:
* E-mail:
* Address:
* City, State, Zip:
Part Number:
Pkg. Type:

1.
Process:

2.
Standardization Spec (i.e. JEDEC/Military/ESD)  
  • Condition (i.e. A,B...)
3. ESD Testing & Latch-up Testing, please complete our questionnaire.

4. Please attach device specification (i.e. Burn-in Circuit) with Imax.

5.
Total number of hours:
  • Pulls at:
 		 

6.
Temperature/Humidity Condition:

7.
Total Number of cycles:
  • Pulls at:
 		 

8.
Preconditioning Level:  
  • Pre-CSAM:
 		Yes    No
  • Post-CSAM:
 		Yes    No

Special Instruction:

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