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CAS Registry Number(R) is a Registered Trademark of the American Chemical Society                                                 Form enabled by Adobe

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Material Composition Declaration

 © Copyright 2005. IPC, Bannockburn, Illinois. All rights reserved under
both international and Pan-American copyright conventions.

This document is a declaration of the substances within the manufacturer listed item. Note: if the item is an assembly
with  lower  level  parts,  the  declaration  encompasses  all  lower  level  materials  for  which  the  manufacturer  has
engineering responsibility.

       

Adobe Reader version 7.0.5  is required to complete this declaration.

IPC-1752-1 v1.02

IPC Web Site for Information on IPC-1752 Standard

http://www.ipc.org/IPC-175x

Form Type *

Declaration Class *

Supplier Information

Company Name *

Company Unique ID

Unique ID Authority

Response Date *

Response Document ID

Contact Name *

Title - Contact

Phone - Contact *

Email - Contact *

Authorized Representative *

Title - Representative

Phone - Representative *

Emai

l

 - Representative

 *

Supplier Comments or URL for Additional Information

 Requester Item Number

Mfr Item Number

Mfr Item Name

Effective Date

Manufacturing Site

Weight

UOM

Unit Type

Version

Alternate Recommendation

Alternate Item Comments

Manufacturing Information section intentionally omitted.

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