Microcontroller & Digital Signal Controller QTP/SQTP ORDER FORM

Microchip Technology Inc., 2355 West Chandler Blvd., Chandler, Arizona, 85224-6199 USA. Phone: 1-800-437-2767
All Boxes On This Form Must Be Completed, Otherwise No Action Will Be Taken Note:  denotes required fields.

Email Address:
Company/University
Address(City, State, Zip, Country):
Registered User:
Special Instructions:
End Customer Name:

Shipping Information:

Ship To:
Company/University
Shipping Address:
Phone (helps with shipment tracking) #:

Are you working with Microchip Sales Person?

Microchip Sales Person Name:
Email Address:

Application Information:
Device Selection Note: All Packages are Pb-free

Program Name:
Device:
Package:
Your Part Number (Optional):

1) Does this device require special testing similar to an existing Microchip device?
If yes, enter existing part number:
2) Has Microchip previously approved a device specification for this product?
If yes, advise your specification or NSCAR number:

Serialization:
Serialization Type:
Start Address:
Number of Addresses:
Start Number(Seq. Only):
Increment(Seq. Only):
Stop Number(if required, optional):
Seed(Psuedo Only):
Serial Number Memory Location:
Part Marking:
1st Line:
2nd Line:
3rd Line:
4th Line:
5th Line:
6th Line:
7th Line:
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YY=Year, WW=Week, NNN=Lot Tracking Number:

ID Memory:
Checksum:
MPLAB version:
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Version:1
I agree to the Terms and Conditions

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Terms and Conditions!

As an authorized representative of Customer, I represent and agree that:

a. The markings and options above are correct and should be used to generate prototypes for shipment to Customer, including the identified code as designated by the first line of the special marking guidelines (XXX).

b. The contents of the memory cannot practicably be verified or changed once the code protection bit is set.

c. Microchip is authorized to manufacture and ship to Customer and Customer's designee the above mentioned device with enclosed code (firmware) upon Customer's written prototype approval and receipt of a production purchase order.

d. If code was provided to Microchip by or on behalf of Customer, Customer warrants that it has secured all intellectual property rights necessary to allow Microchip to integrate such code in semiconductor components for the benefit of Customer. Customer further warrants that customer code provided does not contain encryption or cryptographic functionality that is subject to a U.S.Department of Commerce, Commodity Control List (CCL) designation other than EAR99 and will not require an export license for shipment to the customer's locations from the U.S. or the U.K.

e. Microchip only warrants that its production devices conform to the applicable Microchip datasheet. Microchip's provision of prototypes or final products to Customer does not modify or expand Microchip's warranty or liability for device performance as stated in Microchip's terms and conditions of sale.

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Statement of End-use and Export Compliance!

End-Use Certificate

Microchip Technology Incorporated, to include all of its affiliates and subsidiaries wherever situated (collectively referred to as “Microchip”), reserves the right to require a party receiving Microchip Product, Technology, and/or Services (“Recipient”) to evidence their export regulatory diligence by executing this document (the “EUC”). In so doing, the Recipient agrees and undertakes to comply with all dual-use export and re-export control laws, regulations, and/or orders governing the use of, or distribution of, Microchip Product, Technology, and/or Services under auspices including, but not limited to, the United States (“the US”) and the European Union (“the EU”).

The primary regulations concerning exports and re-exports are controlled by the U.S. Department of Commerce and Department of State, European Union, and local country legislation, all of which relate to hardware, software and technology. More information is available from the following sites.


US Department of Commerce Bureau of Industry and Security http://www.bis.doc.gov/
US Department of State Directorate of Defense Trade Controls http://pmddtc.state.gov/
US Department of Treasury Office of Foreign Assets Control http://www.treasury.gov/about/organizational-structure/offices/Pages/Office-of-Foreign-Assets-Control.aspx
European Union http://europa.eu/legislation_summaries/external_trade/index_en.htm
Local Country Regulations http://www.wassenaar.org/

This agreement includes, but is not limited to, the following statements:

  1. Recipient certifies that it shall not knowingly cause any denied or sanctioned parties, entities, or organizations to receive Microchip Product, Technology, and/or Services except as authorized by law.
  2. Recipient certifies that it will use Microchip Product, Technology, and/or Services for civil end-uses and not for any unauthorized military end-use (as defined in the relevant laws, regulations and/or orders of, inter alia, the US1 and the EU). Recipient will not use them for chemical, nuclear, biological, or mass destruction weapons development, production, handling, operation, maintenance, storage, detection, identification or dissemination nor the development, production, handling, operation, maintenance, storage, detection, identification or dissemination of missile systems.
    Prohibited end-use includes research on, or development, design, manufacture, construction, testing or maintenance of, any nuclear explosive device or components of subsystems of such a device.
    Prohibited end-use includes research on, or development, design, manufacture, construction, operation or maintenance of, any reactor, critical facility, conversion plant, fabrication plant, reprocessing plant, plant for the separation of isotopes of source or special fissionable material, or separate storage installation, where there is no obligation to accept IAEA safeguards at the relevant facility or installation, existing or future, when it contains any source or special fissionable material; or of any heavy water production plant where there is no obligation to accept IAEA safeguards on any nuclear material produced by or used in connection with any heavy water produced there from; or where any such obligation is not met.
  3. Recipient will not knowingly re-export or otherwise re-sell or transfer any Microchip Product, Technology, and/or Services to any third party who does not make the declaration laid down in point 2 above.
  4. In consideration for receiving Microchip Product, Technology, and/or Services, Recipient acknowledges understanding of it, and its subsidiaries, agents, and related parties sole responsibility for remaining aware and compliant with US and EU dual-use export and re-export control laws, regulations, and/or orders in effect.
  5. Recipient certifies that all the statements and facts contained in this Certification are true and correct to the best of its knowledge and belief and it does not know of any additional facts that are inconsistent with this Certification. Recipient must continuously review its compliance with this Certification and promptly send a supplemental certification to Microchip disclosing any change of facts or statements in this Certification.

This Certification shall survive the term and termination of any relationship between Microchip and Recipient.

Should you have need of further advice or instructions, please do not hesitate to contact your local Microchip Representative.

1 As of June 29, 2020, US export regulation was amended with respect prohibitions of “military end-use” in China, Russia, and Venezuela. As part of the required due diligence, Recipient agrees to review 85 Federal Register 23459 and 85 Federal Register 34306
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