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(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.)
S3C SERIES
REQUEST FOR PRODUCTION AT CUSTOMER RISK
Customer Information:
Company Name: ________________________________________________________________
Department: ________________________________________________________________
Telephone Number: __________________________ Fax: _____________________________
Date: __________________________
Risk Order Information:
Device Number: S3C________- ________ (write down the ROM code number)
Package: Number of Pins: ____________ Package Type: _____________________
Intended Application: ________________________________________________________________
Product Model Number: ________________________________________________________________
Customer Risk Order Agreement:
We hereby request SEC to produce the above named product in the quantity stated below. We believe our risk order
product to be in full compliance with all SEC production specifications and, to this extent, agree to assume
responsibility for any and all production risks involved.
Order Quantity and Delivery Schedule:
Risk Order Quantity: _____________________ PCS
Delivery Schedule:
Delivery Date (s) Quantity Comments
Signatures: _______________________________ _______________________________________
(Person Placing the Risk Order) (SEC Sales Representative)