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POST https://chip120100.activehosted.com/proc.php

<form method="POST" action="https://chip120100.activehosted.com/proc.php" id="_form_17_" class="_form _form_17 _inline-form  _dark" novalidate="">
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  <div class="_form-content">
    <div class="_form_element _x75919857 _full_width _clear">
      <div class="_form-title"> Request for the complete list of part numbers affected </div>
    </div>
    <div class="_form_element _x50823877 _full_width ">
      <label for="fullname" class="_form-label"> Full Name* </label>
      <div class="_field-wrapper">
        <input type="text" id="fullname" name="fullname" placeholder="Type your name" required="" data-name="fullname">
      </div>
    </div>
    <div class="_form_element _x90413081 _full_width ">
      <label for="email" class="_form-label"> Email* </label>
      <div class="_field-wrapper">
        <input type="text" id="email" name="email" placeholder="Type your email" required="" data-name="email">
      </div>
    </div>
    <div class="_form_element _x39896867 _full_width ">
      <label for="phone" class="_form-label"> Phone* </label>
      <div class="_field-wrapper">
        <input type="text" id="phone" name="phone" placeholder="Type your phone number" required="" data-name="phone">
      </div>
    </div>
    <div class="_form_element _x55530347 _full_width ">
      <label for="field[32]" class="_form-label"> Country * </label>
      <div class="_field-wrapper">
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          <option selected="">
          </option>
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          <option value="United Arab Emirates"> United Arab Emirates </option>
          <option value="United Kingdom"> United Kingdom </option>
          <option value="China"> China </option>
          <option value="India"> India </option>
          <option value="Philippines"> Philippines </option>
          <option value="Afghanistan"> Afghanistan </option>
          <option value="Albania"> Albania </option>
          <option value="Algeria"> Algeria </option>
          <option value="American Samoa"> American Samoa </option>
          <option value="Andorra"> Andorra </option>
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          <option value="Anguilla"> Anguilla </option>
          <option value="Antarctica"> Antarctica </option>
          <option value="Antigua and Barbuda"> Antigua and Barbuda </option>
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          <option value="Armenia"> Armenia </option>
          <option value="Aruba"> Aruba </option>
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          <option value="Austria"> Austria </option>
          <option value="Azerbaijan"> Azerbaijan </option>
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          <option value="Belize"> Belize </option>
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          <option value="Bermuda"> Bermuda </option>
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          <option value="Burkina Faso"> Burkina Faso </option>
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          <option value="Christmas Island"> Christmas Island </option>
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          <option value="Congo, the Democratic Republic of the"> Congo, the Democratic Republic of the </option>
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          <option value="Costa Rica"> Costa Rica </option>
          <option value="Cote D'Ivoire"> Cote D'Ivoire </option>
          <option value="Croatia"> Croatia </option>
          <option value="Cuba"> Cuba </option>
          <option value="Cyprus"> Cyprus </option>
          <option value="Czech Republic"> Czech Republic </option>
          <option value="Denmark"> Denmark </option>
          <option value="Djibouti"> Djibouti </option>
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          <option value="Dominican Republic"> Dominican Republic </option>
          <option value="Ecuador"> Ecuador </option>
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          <option value="Ethiopia"> Ethiopia </option>
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          <option value="French Guiana"> French Guiana </option>
          <option value="French Polynesia"> French Polynesia </option>
          <option value="French Southern Territories"> French Southern Territories </option>
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          <option value="Greenland"> Greenland </option>
          <option value="Grenada"> Grenada </option>
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          <option value="Guatemala"> Guatemala </option>
          <option value="Guinea"> Guinea </option>
          <option value="Guinea-Bissau"> Guinea-Bissau </option>
          <option value="Guyana"> Guyana </option>
          <option value="Haiti"> Haiti </option>
          <option value="Heard Island and Mcdonald Islands"> Heard Island and Mcdonald Islands </option>
          <option value="Holy See (Vatican City State)"> Holy See (Vatican City State) </option>
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          <option value="Hong Kong"> Hong Kong </option>
          <option value="Hungary"> Hungary </option>
          <option value="Iceland"> Iceland </option>
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          <option value="Iran, Islamic Republic of"> Iran, Islamic Republic of </option>
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          <option value="Lao People's Democratic Republic"> Lao People's Democratic Republic </option>
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          <option value="Lesotho"> Lesotho </option>
          <option value="Liberia"> Liberia </option>
          <option value="Libyan Arab Jamahiriya"> Libyan Arab Jamahiriya </option>
          <option value="Liechtenstein"> Liechtenstein </option>
          <option value="Lithuania"> Lithuania </option>
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          <option value="Macedonia, the Former Yugoslav Republic of"> Macedonia, the Former Yugoslav Republic of </option>
          <option value="Madagascar"> Madagascar </option>
          <option value="Malawi"> Malawi </option>
          <option value="Malaysia"> Malaysia </option>
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          <option value="Marshall Islands"> Marshall Islands </option>
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          <option value="Mauritania"> Mauritania </option>
          <option value="Mauritius"> Mauritius </option>
          <option value="Mayotte"> Mayotte </option>
          <option value="Mexico"> Mexico </option>
          <option value="Micronesia, Federated States of"> Micronesia, Federated States of </option>
          <option value="Moldova, Republic of"> Moldova, Republic of </option>
          <option value="Monaco"> Monaco </option>
          <option value="Mongolia"> Mongolia </option>
          <option value="Montserrat"> Montserrat </option>
          <option value="Morocco"> Morocco </option>
          <option value="Mozambique"> Mozambique </option>
          <option value="Myanmar"> Myanmar </option>
          <option value="Namibia"> Namibia </option>
          <option value="Nauru"> Nauru </option>
          <option value="Nepal"> Nepal </option>
          <option value="Netherlands"> Netherlands </option>
          <option value="Netherlands Antilles"> Netherlands Antilles </option>
          <option value="New Caledonia"> New Caledonia </option>
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          <option value="Nigeria"> Nigeria </option>
          <option value="Niue"> Niue </option>
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          <option value="Northern Mariana Islands"> Northern Mariana Islands </option>
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          <option value="Puerto Rico"> Puerto Rico </option>
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          <option value="Reunion"> Reunion </option>
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          <option value="Saint Kitts and Nevis"> Saint Kitts and Nevis </option>
          <option value="Saint Lucia"> Saint Lucia </option>
          <option value="Saint Pierre and Miquelon"> Saint Pierre and Miquelon </option>
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          <option value="San Marino"> San Marino </option>
          <option value="Sao Tome and Principe"> Sao Tome and Principe </option>
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          <option value="Senegal"> Senegal </option>
          <option value="Serbia and Montenegro"> Serbia and Montenegro </option>
          <option value="Seychelles"> Seychelles </option>
          <option value="Sierra Leone"> Sierra Leone </option>
          <option value="Singapore"> Singapore </option>
          <option value="Slovakia"> Slovakia </option>
          <option value="Slovenia"> Slovenia </option>
          <option value="Solomon Islands"> Solomon Islands </option>
          <option value="Somalia"> Somalia </option>
          <option value="South Africa"> South Africa </option>
          <option value="South Georgia and the South Sandwich Islands"> South Georgia and the South Sandwich Islands </option>
          <option value="Spain"> Spain </option>
          <option value="Sri Lanka"> Sri Lanka </option>
          <option value="Sudan"> Sudan </option>
          <option value="Suriname"> Suriname </option>
          <option value="Svalbard and Jan Mayen"> Svalbard and Jan Mayen </option>
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          <option value="Timor-Leste"> Timor-Leste </option>
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          <option value="Trinidad and Tobago"> Trinidad and Tobago </option>
          <option value="Tunisia"> Tunisia </option>
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          <option value="Turkmenistan"> Turkmenistan </option>
          <option value="Turks and Caicos Islands"> Turks and Caicos Islands </option>
          <option value="Tuvalu"> Tuvalu </option>
          <option value="Uganda"> Uganda </option>
          <option value="Ukraine"> Ukraine </option>
          <option value="United States Minor Outlying Islands"> United States Minor Outlying Islands </option>
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          <option value="Virgin Islands, U.s."> Virgin Islands, U.s. </option>
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          <option value="Western Sahara"> Western Sahara </option>
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          <option value="Zambia"> Zambia </option>
          <option value="Zimbabwe"> Zimbabwe </option>
          <option value="Shanghai"> Shanghai </option>
          <option value="Shenzhen"> Shenzhen </option>
          <option value="Shanghai "> Shanghai </option>
        </select>
      </div>
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    <div class="_form_element _x82800514 _full_width ">
      <label for="field[3]" class="_form-label"> Company * </label>
      <div class="_field-wrapper">
        <input type="text" id="field[3]" name="field[3]" value="" placeholder="" required="" data-name="company">
      </div>
    </div>
    <div class="_form_element _x97196187 _full_width ">
      <label for="field[33]" class="_form-label"> Position* </label>
      <div class="_field-wrapper">
        <input type="text" id="field[33]" name="field[33]" value="" placeholder="" required="" data-name="position">
      </div>
    </div>
    <div class="_form_element _x76576851 _full_width ">
      <label for="field[31]" class="_form-label"> Message </label>
      <div class="_field-wrapper">
        <textarea id="field[31]" name="field[31]" placeholder="" data-name="message"></textarea>
      </div>
    </div>
    <div class="_button-wrapper _full_width">
      <button id="_form_17_submit" class="_submit" type="submit"> Submit </button>
    </div>
    <div class="_clear-element">
    </div>
  </div>
  <div class="_form-thank-you" style="display:none;">
  </div>
</form>

Text Content

Request for the complete list of part numbers affected
Full Name*

Email*

Phone*

Country *
United States Germany United Arab Emirates United Kingdom China India
Philippines Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla
Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria
Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin
Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil
British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi
Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad
Chile Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the
Democratic Republic of the Cook Islands Costa Rica Cote D'Ivoire Croatia Cuba
Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt
El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands
(Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia
French Southern Territories Gabon Gambia Georgia Ghana Gibraltar Greece
Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti
Heard Island and Mcdonald Islands Holy See (Vatican City State) Honduras Hong
Kong Hungary Iceland Indonesia Iran, Islamic Republic of Iraq Ireland Israel
Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's
Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic
Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein
Lithuania Luxembourg Macao Macedonia, the Former Yugoslav Republic of Madagascar
Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania
Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of
Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal
Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger
Nigeria Niue Norfolk Island North Macedonia Northern Mariana Islands Norway Oman
Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay
Peru Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian
Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre
and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and
Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone
Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia
and the South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan
Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan
Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad
and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda
Ukraine United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu
Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.s. Wallis and
Futuna Western Sahara Yemen Zambia Zimbabwe Shanghai Shenzhen Shanghai
Company *

Position*

Message

Submit