------ Free-of-Charge Upgraded R0E521000EPBM0 MCU Board Application Form 
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SEND TO: Your local Renesas Technology sales office or distributor

Effective Date of Application: From February 1 to August 30, 2006

        Free-of-Charge Upgraded R0E521000EPBM0 MCU Board Application Form
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Date of Application:

Product Information
  Product Type:
  Check the product(s) you want to upgrade; also be sure to enter 
  the serial number of yours.
            ( ) R0E521000CPE00(WS)   Serial No.:
            ( ) R0E521000CPE00(ES)   Serial No.:
            ( ) R0E521000EPB00(WS)   Serial No.:
            ( ) R0E521000EPB00(ES)   Serial No.:

FROM:
  Customer Company:
  Customer Section:
  Customer Contact Person:
  Address:
   City                      State                 Zip
                             Country
  Phone:                          Extension:
  FAX:
  E-mail Address:

Message:



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