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To: Renesas Technology sales office or distributor

M30800T-PTC Free-of-Charge Replacement
Application Form

Date ___________________

[Effective Date of Application:]
From June 16, 2003, to June 15, 2004, inclusive

[Product Information:]
Product Type
Serial No.Be sure to enter Serial No. of yours.
M30800T-PTC
Identification
Code
___ <- Check when your board has an identification code,
and if so, fill it in _______________ .
The code is inscribed on top of your boards.


[Customer:]
Company Name
Section
Contact Person
Phone
Fax
E-mail Address
Address


[Message:]




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