Products & Services

HDMI ATC Testing Order Form - USA

HDMI Logo

*Note: Fields with an asterisk are required.

HDMI Adopter Name:
HDMI Adopter's Contact Email: Please enter a valid email address for the adopter (with no spaces at the beginning or ending of the address).
Note: If you are an ODM please enter your adopter's name and contact email address before placing an order.

Bill To

PO Number:
*Company Name:
*Company Address:
Company Address 2:
Company Address 3:
Company Address 4:
*Company City:
*Company Postal Code:
*Company State/Province:
*Company Country:
*Contact Name:
Division/Dept:
* Email:
Phone Number:

Primary Contact
(If different from above fill in below contact info.)

Contact Name:
Contact Email: Please enter a valid Primary Contact email address (with no spaces at the beginning or ending of the address).
Contact Phone:

Product Details
(Required if ordering product testing at this time.)

*Test Center Location:
(Pick the test center where you will submit your device.)
   Test Center Locations »
*Planned ship date:
(Approximate date you plan to ship the device to the test center.)
 (mm/dd/yyyy)
*Product Class:
*Vendor Name:
*Model Name:
*Model Number:
Firmware Version:

Product Testing Resubmission?
(Check if this is a resubmission and provide the original order# in the next box.)
Resubmission.
      

Original Order #:
(is required if this is a resubmission)

Premium Cable Compliance Testing

Qty

UHDA ULTRA HD Premium

Qty

HDMI ATC Certificate Testing (HDMI 1.4) ONLY

Please note: A quote will be provided after your DUT testing configuration has been submitted..
Qty

HDMI 2.1 Compliance COMBO Testing (includes 1.4b)

Note: Please add OPTIONAL items below for each additional port you support (e.g., HDCP $500/port or YC444/port)..
Qty

Optional Items (HDMI 1.4b & 2.1)

Qty
Pre-Test Service
Note: Select to request a quote

Expedite Testing Service
Note: Select to request a quote


Consulting

Qty
Simplay Consulting


Return Ship To

Note: Manufacturer is required to provide a Return Waybill Shipment Label at the time of submission. If a Return Waybill Shipment Label is not provided at the time of submission, a $500.00USD disposal fee for (Sink, Source, Repeaters) and $100.00USD for (Cables) will be charged to the order.

*Preferred Method of Shipment:
* Preferred Carrier:
* Carrier Account Number:
* Declared value for return shipment:
ECCN/HTS codes:
(for International shipments)
* Contact Name:
* Company Name:
Division/Dept:
* Company Address:
* Contact Email:
* Contact Phone:

Upload File(s)

Select the file(s) on your computer to attach to your order.

Capabilities Declaration Form (CDF):
HDCP:
Special Instructions:

Comments

Note: If you have not done so already, please remember to submit your CDF and HDCP documents prior to your equipment arriving to admin_simplay@simplaylabs.com and reference your confirmation #.