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    Custom-Made Products Request Form
    1.The Requirement Information
    *Customer Name *LCM Spec.Description
    *Custoemr Location *Qty.of the Requirement
    End User Name *Estimated Yearly Usage
    End User Location Terms of Payment
    Contact CSO/CSA Customer Target Quotation
    2.Product Application
    100Transportation Vehicle (Including Aviation/Automotive /Maritime 106 Game/Toys
    101 Entertainment Device (Including Audio/Video /VCR/ Camcorder / Walkman) 107 Calculators, Watches
    102 Telecommunication (Including CellPhone /Pagers /In-house Phone) 108 Educational Kits
    103 Office Application (e.g. Typewriter / Copiers 109 Health Care Products
    104 CIT,PDAs, Electronic Diary , Electronic dictionary 110 Industrial Appliances
    105 Home Application (e.g. Cooker, Oven, Refrigerator, Air-conditioner) 111 Instrumental
    3.Check List For LCM Specification
    A. Spec / Drawing Attached (No. ) is Modification Required? No, Yes, Please indicate in ITERM"C"
    B. Sample Attached (No. )is Modification Required? No, Yes, Please indicate in ITERM"C"
    C. Other Information (Pls refer to Detail Information as Below)
    LCD Specification Screen Size
    Module Size ( W *H *T )mm
    Viewing area ( W * H )mm
    Active area ( W *H )mm
    Dot Pitch ( W *H )mm
    Display Resolution
    Display  Mode Reflective Transflective Transmissive Antiglare
    Pin No
    Contrast ratio
    Viewing angle
    Viewing Direction 6 O'clock 12 O'clock Other
    Gray Scale Yes No
    Driving Frequency Frame Frequency  ( ) Hz
    Operation Voltage Control Method Fixed  ( )  V; Adjustable   ( )V
    Temperature Compensation Yes No
    Operating Voltage (Vop) ( )  V
    Supply Voltage for Logic(Vdd) ( ) V
    Supply Voltage for LCD Built-in(Boost Voltage) Supplying Outside
    LCD Connector TAB H/S Zebra COG FPC Other
    Specific Driver Yes( ) No
    Controller Yes( ) No
    Interface Pin Defined Yes( ) No
    Backlight Yes  □EL  (Color: )
    LED (Color: ) Side       □Bottom
    Backlight Inserter Yes No
    MD Brightness ( ) cd/m
    Power Consumption ( ) MW (Max.)
    Weight ( )g
    Quality Specification Reliablility STD
    Other Specific Requirement HQ     High Temperature Storage: ℃ * Hrs
    Low Temperature Storage: ℃ * Hrs
    High termperature and Humidity storage:
    %Rh* Hrs
    Thermal Shock ( )
    Operating Temperature (Top) ( ) ℃
    Storage Temperature (Tst) ( ) ℃
    Price Target price ( /pc  )
    Tooling charge ( /set )
    Schedule Engineering sample ( )pcs on ( )dd/mm/yy
    Pilot Run ( )pcs on ( )dd/mm/yy
    Mass Production ( ) k/month on ( )dd/mm/yy
    Sales  Forecast ( ) k/month * ( )month
    (from to )
    Package Packaging STD Customer Indicating Requirement

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