*Supplier Part Number / Description |
* Required
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*TI Part Number |
* Required
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*TI Part Revision |
* Required
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*Material Group |
* Select a Material Group
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*Safety and/or Government Regulations ("Yes" if so indicated by the design record, otherwise "No".) |
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*Supplier Name |
* Required
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Supplier Code |
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*Street Address |
* Required
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*City |
* Required
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*State/Province |
* Required
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Postal Code | |
*Country |
* Required
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Customer Name: Texas Instruments | |
Buyer | |
Buyer Code | |
Application ((If known, Ex. 20x20 QFP, 16 pin SOIC) | |
*Reason for Submission (Check one or more) | |
- Initial Submission |
* Select Yes or No
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- Change to Optional Construction or Material |
* Select Yes or No
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- Engineering Change(s) |
* Select Yes or No
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- Sub-Supplier or Material Source Change |
* Select Yes or No
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- Tooling: Transfer, Replacement, Refurbishment, or additional |
* Select Yes or No
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- Change in Part Processing |
* Select Yes or No
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- Correction Of Discrepancy |
* Select Yes or No
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- Parts Produced at Additional Location |
* Select Yes or No
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- Tooling inactive for more than 1 year |
* Select Yes or No
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- Other(Please specify) |
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*Requested Submission Level |
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*Do Submission Results as defined in Appendix B of TI document 6458266 and all process parameters meet all drawing and specification requirements? |
* Select Yes or No
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If NO please explain: |
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Declaration: I affirm that the samples represented by this warrant are representative of our parts, which were made by a process that meets all Production Part Approval Process Manual 4th Edition Requirements. I also certify that documented evidence of such compliance is on file and available for review. I have noted any deviation from this declaration to the right: PSW Waiver Form |
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*Name |
* Required
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*Title |
* Required
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*Email |
* Required
Not a valid e-mail address. Must follow email@host.domain
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*Phone |
* Required
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