ICC-QMC-DGC Daughter Card Request Form
Request a QMC Daughter Card
Submit your contact information and an ICC-QMC-DGC Daughter Card quote.
All fields are required.
First Name
Last Name
Email Address
Full Company Name
Country
Country (Required)
UNITED STATES
AFGHANISTAN
ALBANIA
ALGERIA
AMERICAN SAMOA
ANDORRA
ANGOLA
ANTARCTICA
ANTIGUA
ARGENTINA
ARMENIA
AUSTRALIA
AUSTRIA
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BERMUDA
BHUTAN
BOLIVIA
BOSNIA-HERZEGOVINA
BOTSWANA
BOUVET ISLAND
BRAZIL
BRITISH INDIAN OCEAN TERRITORY
BRITISH VIRGIN ISLANDS
BRUNEI
BULGARIA
BURKINA FASO
BURUNDI
CAMBODIA
CAMEROON
CANADA
CAPE VERDE
CAYMAN ISLANDS
CENTRAL AFRICAN REPUBLIC
CHAD
CHILE
CHINA
CHRISTMAS ISLAND
COCOS (KEELING) ISLANDS
COLOMBIA
COMORO ISLANDS
CONGO
CONGO, THE DEMOCRATIC REPUBLIC OF THE
COOK ISLANDS
COSTA RICA
CÔTE D'IVOIRE
CROATIA
CYPRUS
CZECH REPUBLIC
DENMARK
DOMINICA
DOMINICAN REPUBLIC
ECUADOR
EGYPT
EL SALVADOR
EQUATORIAL GUINEA
ESTONIA
ETHIOPIA
FALKLAND ISLANDS (MALVINAS)
FAROE ISLANDS
FIJI
FINLAND
FRANCE
FRENCH GUIANA
FRENCH POLYNESIA
FRENCH SOUTHERN TERRITORIES
GABON
GAMBIA
GEORGIA
GERMANY
GHANA
GIBRALTAR
GREECE
GREENLAND
GRENADA
GUADELOUPE
GUAM
GUATEMALA
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HEARD AND MCDONALD ISLANDS
HONDURAS
HONG KONG
HUNGARY
ICELAND
INDIA
INDONESIA
IRAQ
IRELAND
ISRAEL
ITALY
JAMAICA
JAPAN
JORDAN
KAZAKHSTAN
KENYA
KOREA, REPUBLIC OF
KUWAIT
LAOS
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACEDONIA
MADAGASCAR
MALAWI
MALAYSIA
MALDIVES
MALI
MALTA
MARTINIQUE
MAURITANIA
MAURITIUS
MEXICO
MOLDOVA
MONACO
MONGOLIA
MONTENEGRO
MONTSERRAT
MOROCCO
MOZAMBIQUE
NAURU
NEPAL
NETHERLANDS
NEW CALEDONIA
NEW ZEALAND
NICARAGUA
NIGER
NIGERIA
NIUE
NORFOLK ISLAND
NORWAY
OMAN
PAKISTAN
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
PITCAIRN
POLAND
PORTUGAL
PUERTO RICO
QATAR
RÉUNION
ROMANIA
RUSSIAN FEDERATION
RWANDA
SAINT HELENA
SAINT LUCIA
SAINT PIERRE AND MIQUELON
SAINT VINCENT
SAN MARINO
SAO TOME AND PRINCIPE
SAUDI ARABIA
SENEGAL
SERBIA
SEYCHELLES
SIERRA LEONE
SINGAPORE
SLOVAKIA
SLOVENIA
SOLOMON ISLANDS
SOMALIA
SOUTH AFRICA
SPAIN
SURINAME
SWAZILAND
SWEDEN
SWITZERLAND
TAIWAN
TANZANIA
THAILAND
TOGO
TOKELAU
TONGA
TRINIDAD AND TOBAGO
TUNISIA
TURKEY
TURKMENISTAN
TURKS AND CAICOS ISLANDS
UGANDA
UKRAINE
UNITED ARAB EMIRATES
UNITED KINGDOM
UNITED STATES
URUGUAY
VATICAN CITY
VENEZUELA
VIETNAM
VIRGIN ISLANDS OF THE U.S.
WALLIS AND FUTUNA
YEMEN
ZAMBIA
ZIMBABWE
Primary Business
Primary Business
Aerospace
Automotive
Consultant/Design House
Consumer
Distributor
EMSI
Education
Government
Home Automation
Industrial/Commercial
Media/Analyst
Medical
Military
Mobile Communications
Networking Infrastructure
Other
Point of Sale
Research and Development
Security
Tools Vendor (RTOS, H/W, S/W)
Training
Wireless
Job Description
Job Description
Academic-Professor
Academic-Student
Engineer - Applications
Engineer - Component/Product
Engineer - Design
Engineer - Firmware
Engineer - Hardware
Engineer-Manufacturing/Process
Engineer - Software
Engineer - System
Engineer - System Architect
Field Application Engineer
Marketing
Other
Program/Project Manager
Purchasing/Supply Management
Quality
Sales
Title
Title
Consultant
Director
Executive - Business
Executive - Technical
Individual
Manager
Senior/Team Lead
Staff/Fellow
VP
Work Street Address
City
State or Province
State (required)
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District Of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Province (required)
Anhui
Beijing
Chongqing
Fujian
Gansu
Guangdong
Guangxi Zhuang
Guizhou
Hainan
Hebei
Heilongjiang
Henan
Hubei
Hunan
Jiangsu
Jiangxi
Jilin
Liaoning
Nei Mongol
Ningxia Hui
Qinghai
Shaanxi
Shandong
Shanghai
Shanxi
Sichuan
Tianjin
Xinjiang Uygur
Xizang
Yunnan
Zhejiang
Province (required)
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territories
Nova Scotia
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
ZIP or Postal Code
Work Phone
Product Interest
Product Interest
Product Interest No. 1
Product Interest No. 2
Product Interest No. 3
Please describe your interest in this design
window.location (see JS in head tag)
document.referrer (not working yet)
Type of product you will develop
Target production volume
Target timeline for your product
Additional Single-Line Input (user or admin use)
Additional Single-Line Input (user or admin use)
Additional Paragraph Input (user or admin use)
Additional Paragraph Input (user or admin use)
Additional Paragraph Input (user or admin use)
Additional Paragraph Input (user or admin use)
Additional Paragraph Input (user or admin use)
Additional checkbox (user or admin use)
Additional checkbox (user or admin use)
Additional checkbox (user or admin use)
Additional checkbox (user or admin use)
Additional checkbox (user or admin use)
Single Picklist 1
Single Picklist 1
Picklist 1, Option 1
Picklist 1, Option 3
Picklist 1, Option 3
Single Picklist 2
Single Picklist 2
Picklist 2, Option 1
Picklist 2, Option 2
Picklist 2, Option 3
Single Picklist 3
Single Picklist 3
Picklist 3, Option 1
Picklist 3, Option 2
Picklist 3, Option 3
Single Picklist 4
Single Picklist 4
Picklist 4, Option 1
Picklist 4, Option 2
Picklist 4, Option 3
Single Picklist 5
Single Picklist 5
Picklist 5, Option 1
Picklist 5, Option 2
Picklist 5, Option 3
I give my permission to share my information with Authorized NXP Distribution Partners
— Please Select —
Yes
No
Yes, I would like to receive important technical updates and information on new products, training, and more from NXP.
Receive Email Opt In (CHECKBOX FIELD 38 SELECTS THIS)
Yes
No
Low
Text in here