< Required fields marked with >

 First Name:

 Last Name:

Title:

 Organization:

Street Address:

Mailing Address:

City / Town:

State / Province:

Zip / Postal Code:

Country:

 Phone:

Fax:

E-Mail:

   Project Schedule

Immediate, project ready to go Within 1-3 months Over 3 months Budgetary only  

a) Part Name and Number:

b) Please quote the following items:

PCB Assembly Only

PCB Assembly & Material Procurement

PCB Assembly, Material Procurement & Board Fabrication

Other (complete special requirements field)

c) ROHS Compliant?

No Yes  

a) Layer Count:

1 2 Other       Other Count:    

a) Material:

FR-4 CEM-1 Other       Other Material:    

c) Material Thickness (inches):

0.062 Other       Other Thickness:    

d) Dimensions (inches):                    X 

e) For Thru-Hole:

      Approx. # of Holes:   Smallest Hole Size (in mills):

f) If Surface Mount Parts - Qty SMT Pads:

      Qty. Top Side:                  Qty. Bottom Side:       

g) Min. Trace Width (in mills):    Min. Spacing (in mills):

h) Silk-screen:

Top Bottom Both

i) Soldermask:

Top Bottom Both

j) Copper Weights:

1 oz 2 oz Other       Other Weights:    

k) Fabrication Turn Time:

1 Day 2 Days 3 Days 4 Days 1 Week 2 Weeks Other       Other Time:    

l) Quantity of PCB's Required:      

   Please enter any special requirements or notes:

Component count:

  Top - Quantities:          SMT Qty:     Thru-Hole Qty:

  Bottom - Quantities:    SMT Qty:     Thru-Hole Qty:

  Quantity of Assemblies Required:   

  Assembly Turn Time Requested:     

   Please enter any special requirements or notes: