CUSTOMER INFORMATION

* Required

*Company Name:
*Address:
*City:
*State:
*Zip Code:
*First Name:
*Last Name:
*Email Address:
Fax:
*Phone:

BOARD INFORMATION

Part Number and Description
Board Type:	Single Sided  Double Sided   Multilayer  If Multilayer Enter Number of Layers
Material:	FR4  CEM1  CEM3  Teflon  Polyimide  Flex (Kapton)
Board Dimensions:	X =   Y =
Panelize:	Yes  No If yes:  Scoring  Breakaway Tabs
Ounces of Copper:	1  2 3
Number of Vias:
Size of Vias:
Type:	Surface Mount  Mixed Lines
Solder Mask:	Yes  No If Yes:  One Side  Two Sides If Yes:  Wet  LPI
Solder Mask Color:	Green  White  Black   Other
Silk Screen:	One Side  Two Sides  None
Silk Screen Color:	White  Black  Yellow   Other
Gold:	Yes  No If Yes:  Fingers  Imersion  Electrolytic
Palladium:	Yes  No
Electrical Testing:	Yes  No If Yes:  Comparison Test (one time setup) If Yes:  Probe Test (setup fee each time) If Yes:  Clamshell Test (one time setup)
SMT Pad:	One  Both  None
SMT Pads Pitch:
Number of SMT Pads:	Side One Side Two
Line Width:
Line Space:
Slots:	Yes  No
Slots Plated:	Yes  No
Edge Plating Needed:	Yes No
Cut Out:	Yes  No
Carbon Ink:	Yes  No

Please list quantity, lead time and your bid requirements:

Quantity	Lead Time	Bid

Any Special Instructions:

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