MHL Testing Order Form - USA

*Note: Fields with an asterisk are required.

Please Note: ATC will stop testing to MHL CTS 3.2 on November 22, 2015


Name:
Contact Email:
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:
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)
MHL ATC Certificate Testing (1.x) Qty Pre-Test Service MHL Consulting Service MHL ATC Certificate Testing (2.x) Qty Expedite Testing Service Note: Select to request a quote Pre-Test Service MHL Consulting Service MHL ATC Certificate Testing (3.x) HDCP Testing is not included in the testing fee. Qty Pre-Test Service Note: Select to request a quote MHL Consulting Service 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 $200.00USD disposal fee for (Sink, Source, Dongle) and $50.00USD 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 prior to your equipment arriving to admin_simplay@simplaylabs.com and reference your confirmation #.

Products & Services

MHL Testing Order Form - USA

Bill To

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

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

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

MHL ATC Certificate Testing (1.x)

MHL ATC Certificate Testing (2.x)

MHL ATC Certificate Testing (3.x) HDCP Testing is not included in the testing fee.

Consulting

Return Ship To

Upload File(s)

Comments

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

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

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