
(For duplicate copies of this form, and for additional ordering information, please contact your local  
Samsung sales representative. Samsung sales offices are listed on the back cover of this book.) 
S3C9 Series Mask ROM Order Form
Product description:
Device Number:   S3C9__________-_________ (write down the ROM code number) 
Product Order Form: 
__________  
Package 
     Pellet             Wafer  
Package Type:  
Package Marking (Check One):
      Standard  
          Custom A 
(Max 10 chars) 
           Custom B 
(Max 10 chars each line) 
@ : Assembly site code, Y : Last number of assembly year,  WW : Week of assembly 
@ YWW
Device Name
SEC
Device Name
@ YWW
@ YWW
Delivery Dates and Quantities:
Deliverable 
Required Delivery Date 
Quantity 
Comments 
ROM code 
– 
Not applicable 
See ROM Selection Form 
Customer sample 
Risk order 
See Risk Order Sheet 
Please answer the following questions:  
F
 For what kind of product will you be using this order 
     New product 
     Upgrade of an existing product 
If you are replacing an existing product, please indicate the former product name  
 ( 
F
 What are the main reasons you decided to use a Samsung microcontroller in your product 
Please check all that apply. 
     Replacement of an existing product 
     Other 
) 
     Price 
     Product quality 
     Features and  functions 
     Development system  
     Technical support 
     Delivery on time 
     Used same micom before 
     Quality of documentation 
     Samsung reputation 
Mask Charge (US$ / Won):
____________________________ 
Customer Information: 
Company Name: 
___________________            Telephone number  
_________________________ 
Signatures: 
________________________ 
__________________________________ 
(Person placing the order) 
(Technical Manager)