****  Reliability Evaluation/Failure Analysis  **** 
 

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Please complete following and send us back by e-mail.

  Email：fql-evaluation@cs.jp.fujitsu.com 
  
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The objectibe of your incuiry;
  [  ] Quotation    [  ] Order


* Your Name：

  Address: 
    Zip Code:

  Company Name：

  Division：
  Tel:               Fax:          
  E-mail:

* Date of application:

* Due date:

* Do you want us to start test/analysis
   [ ] Immediately   [ ] After you review the quotation 

* Do you need Sample to be sent back?
   [ ] Yes   [ ] No 

* Do you need Documents to be sent back?
   [ ] Yes   [ ] No   

* Contact person for Quotation
   [ ] Same as applicant
   [ ] To the following;

   Name：

   Address: 
    Zip Code:

   Company Name：

   Division：
   Tel:               Fax:          
   E-mail:
   
* Contact person for Invoice
   [ ] Same as applicant
   [ ] Same as the attention for quotation
   [ ] To the following;

   Name：

   Address: 
    Zip Code:

   Company Name：

   Division：
   Tel:               Fax:          
   E-mail:

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[Requirements]

* Subject:


* Objective 
  (Details of your requirements)


* Specimen (Sample)
   -Description
   -Dimension
   -Weight

* Remarks


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