MOSIS Customer Account Request

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


School
 School Name:
 Division/Department:
Administrative Point of Contact
The administrative point-of-contact should be a person with primary organizational responsibility for the account, who communicates with MOSIS about issues related to account access passwords, expiration dates, and other account parameters. The Administrative point-of-contact should be the class professor or instructor. A student may not be the primary contact for an account.

 Primary Contact Name: (should not be a student)
 Last Name: First Name: Middle Name:
 Shipping Address: (We will not ship to a post office box.)
 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:
Technical Point of Contact (If different)
The technical point-of-contact should be a person who answers the students questions about designs, fabrication issues and how to work with MOSIS. The technical point-of-contact can be the class professor, instructor, technical staff or student lead.

 Secondary Contact Name: (should not be a student)
 Last Name: First Name: Middle Name:
 Phone:  Fax:
 Enter only one E-mail Address
 E-mail:
Fabrication Plan
Technology Date
DD-MON-YYYY
Design sizes (mm)