Company

Name

Phone Number

Fax Number

Type of Component

Type of Testing

Please Select One Acceleration/Centrifuge Atmosheric/Altitude Burn-In Clean Room Packaging Capabilities Cross-Sectioning Die Qualification Die Shear/Bond Pull Destructive Physical Analysis (DPA) Dust Electrical Testing Environmental Testing Failure Analysis Fine & Gross Leak Testing Fungus HAST Testing Humidity Materials Analysis Marking/Serializing PIND Programming of IC's Salt Spray/Salt Atmoshere Scanning Electron Microscopy (SEM) Soldering Service Temperature Cycling Thermal Shock Tinning Service Vibration/Shock Wafer Lot Acceptance X-Ray

Part Number

Quantity

Specification

Failure Symptoms (if applicable)

Failure History (if applicable)