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Tape Sample Qualification Form In order to qualify for tape samples, please complete all required fields.  Alternately, please contact our tape specialist.  * indicates a required field

First Name	*
Last Name	*
Title	*
Company	*
Address	*
City	*
State/Province	*
Zip/Postal Code	*
Country
Phone	*
E-mail	*

	What field of technology are you working in?
		Please select: Ink Jet LED MEMS Optics Photonics RF Semiconductor Other, please specify below *

	What material are you using?
		Please select: Ceramic FR4 GaAs Glass Sapphire Silicon Other, please specify below *

	What is your wafer and die size?

	What tape are you currently using?
		Please select: Adwill / Lintec Furukawa Neptco Nitto SEC Ultron Other, please specify below *

	What is the part number of your tape?
		*

	How long and wide is your current tape?
		*

	How many rolls do you use per month?
		*

	What is your current price per roll?
		*

	Please briefly describe your process. *

	Which of our dicing tapes are you interested in? *select all that apply
		Standard dicing tape rolls (Blue Tape) UV curable dicing tape High purity dicing tape Ink jet cover tape

	Do you have any special requests or requirements?

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