Company Name

Contact Person Information (Customer's)
Sex : Mr. Ms.
Given Name :			Family Name :
Job Title :			Department :
Telephone No. :			Fax No. :
Ext. :
E-mail Address :
Company Type : Trading		OEM		ODM
	Manufacturer	Other

Contact Person Information (Mosdesign)
Branch : Taiwan	Hong Kong	China (Shenzhen)
Sales Name :

Shipped Information
Shipped Date :	Y	M	D
IC Type :	CHIP	DIP	SOP
	TO92-3L	TO92-4L	Other
IC Part NO. :		Shipped Qnty : PCS
Lot NO. :		Defective Qnty : PCS
Defective% : %

Application Postion
VDD :	AC	DC
In/Out Put :	Buzzer	Speaker	LED
	Motor	CDS
	Other

Defective Position

IDD Fail

Function Fail

Other