MOSIS Customer Account Request

After you submit your online request, MOSIS Staff will review your request and contact you via email for futher instruction.


Organization
 Organization Name:
 Division/Department:
 What is your organization? (Please check one.)

      Corporation       Academic Institution       Government Agency       Other
 How many years has your organization been in business?   years
 Approximately how many employees work at your location?
 Primary Contact
 Primary Contact Name: (should not be a student)
 Last Name: First Name: Middle Name:
 Address line 1:
 Address line 2:
 Address line 3:
 City:  Postal (ZIP) Code:
 U.S. State:  Province/Region:
 Country:
 Phone:  Fax:
 Enter only one E-mail Address
 E-mail:
 Re-enter
 E-mail:
 Password:  Re-enter
 Password:
 Web Site:
Fabrication Plan
Technology Date
DD-MON-YYYY
Design sizes (mm)