(For duplicate copies of this form, and for additional ordering information, please contact your local
Samsung sales representative. Samsung sales offices are listed on the back cover of this book.)
KS57 SERIES MASK ROM ORDER FORM
Product description:
Device Number: KS57C__________- ___________(write down the ROM code number)
Product Order Form: Package Pellet Wafer Package Type: __________
Package Marking (Check One):
Standard Custom A Custom B
(Max 10 chars) (Max 10 chars each line)
@ : Assembly site code, Y : Last number of assembly year, WW : Week of assembly
@ YWW
Device Name
SEC Device Name
@ YWW @ YWW
Delivery Dates and Quantities:
Deliverable Required Delivery Date Quantity Comments
ROM code –Not applicable See ROM Selection Form
Customer sample
Risk order See Risk Order Sheet
Please answer the following questions:
++ For what kind of product will you be using this order?
New product Upgrade of an existing product
Replacement of an existing product Other
If you are replacing an existing product, please indicate the former product name
( )
++ What are the main reasons you decided to use a Samsung microcontroller in your product?
Please check all that apply.
Price Product quality Features and functions
Development system Technical support Delivery on time
Used same micom before Quality of documentation Samsung reputation
Mask Charge (US$ / Won): ____________________________
Customer Information:
Company Name: ___________________ Telephone number _________________________
Signatures: ________________________ __________________________________
(Person placing the order) (Technical Manager)