Name:    

 Company: 

 Address: 

 City:    

 State:     Zip Code: 

 Phone:      Fax: 

 Email:   

 Component Info

  Number of Surface Mount Components  

 Number of Thru-Hole Components 

 Number of Surface Mount Components on Side One:  Side Two: 

 SMT Pitch: 

 Number of Second Operation Components/Modifications 

 If Yes, Describe:

 Board Info

 Board Size:  X    Thickness: 

 Surface Mount   Thru-Hole   Mixed Technology

 Number of Layers: 

 Final Finish:

 SMOBC: 

 Solder Mask Type: Wet Epoxy   LPI   Dry Film

 Silk Screen: One Sided   Two Sided

 Panelized? Yes   No       Panel Size:  X 

 Number of Boards per Panel:   Gerber Files Supplied? Yes  No

  Delivery Info

 Quantities: 

 Lead Times:  

 Comments/Questions?