Distributors should fill out the yellowed boxes below
DESIGN FORECAST/REGISTRATION REPORTING FORM
ManufacturerProduct Liability ConcernsRegistration Number
Challenge Electronics
Date Submitted:Date Approved
Submitted To
Accepted ByDateExpires
Rejected ByDateRenewal
Reason
DISTRIBUTORLOCATIONTRACKING NUMBER
TSM NameEmailPhone
OS NameEmailPhone
IS NameEmailPhone
CUSTOMER INFORMATION
DISTRIBUTOR ACCOUNT NO.NameCompany Code
Address
Subcontractor No. 3:NameCompany Code
Subcontractor No. 2:NameCompany Code
Subcontractor No. 1:NameCompany Code
Mfg. Account No.
Mfg. Salesperson:EmailPhone
Mfg. FAE:EmailPhone
PROJECT INFORMATION
PROJECT NAME:Description
MARKET SEGMENT:(Application)
Project Status:Prototype Date:Production Date:
CONFIDENCE LEVEL:Units:
Project Engineer:Email:Phone:
Additional Engineer:Email:Phone:
Purchasing Manager:Email:Phone:
PART NUMBER FOR REGISTRATION
Mfg Part NumberDecision DateFut ClassR/ADescriptionA.S.P.QTY/Boards$ 1st Year ProdCF Level
CommentsTotal Value
WIN DateBONUS EARNEDDEBIT NO.
DesignProduction
CLEAR