Thank you for requesting Mouser Electronics' PunchOut Catalog. Please complete this form, and submit to us at your earliest convenience. We will review your request, and contact you if we can meet your requirements and choose to enable the service requested.

Company Name

Mouser Account Number (if known)

Billing Address

Ship-to Address

# of Users

User Locations

Business Contact Person

Name

Title

Email Address

Phone Number

Protocol - OCI* (Preferred) or cXML?

Service Vendor Name (if applicable)

If Ariba, what is your ANID?

Technical Contact

Name

Title

Email Address

Phone Number

Proposed Test Date

Proposed Go Live Date

Do you require lead time**?

Do you have a preferred Login ID?

Do you have a preferred login password?

For cXML - Please indicate which of the following Classification/Extrinsic elements are needed with a "Yes" or "No"

UNSPSC***YesNo

Other Classifications - Mouser can only enable each element as a placeholder, but it won't have any actual values populated.

i. HazardousYesNo

ii. RadioactiveYesNo

iii. ControlledYesNo

iv. Radioactive MinorYesNo

v. SelectAgentYesNo

vi. ToxinYesNo

vii. EnergyStarYesNo

viii. GreenProductYesNo

ix. RecycledYesNo

Extrinsic CASNumber (Placeholder only)