Fill in the fields with as much information known as possibleand press the submit button at the end of this form & then preview and re-submit to mail it to the sales department. If this is a rush delivery, contact the sales department at (973)284-1600.

CONTACT NAME:
COMPANY:
ADDRESS:
CITY:		STATE:		ZIP:
PHONE:		FAX:
SEND QUOTE VIA:	FAX E-Mail Voice
E-MAIL ADDRESS:

PART INFORMATION:
PART #:
REV:
QTY:
LAYER COUNT:
SPECIFICATION:	Custom UL IPC600 Class? Class I Class II Class III
DIMENSIONS:	in. X in.
PLATE THROUGH HOLES:	Yes No
MIN LINE WIDTH:	mils.
SPACE:	mils.
SCORE OR ROUTE ARRAY:	Yes No
ARRAY SIZE:	X
FINISHED COPPER:	oz.
MATERIAL THICKNESS:	.062" .031" .093" .125" .150" .200" .225" .250" .008" .015" <thickness not listed>
FINISH	LEADED SOLDER Rohs - OSP Rohs - TIN Rohs - Lead Free Solder Rohs - ENIG Rohs - Silver
MATERIAL TYPE:	FR-4 FR-5 G-200 GeTek Polyimide Teflon
NUBMER # OF HOLES:
SMALLEST DRILL SIZE:
NUMBER OF SLOTS:
NUMBER OF MASK SIDES:	One Both None
NUMBER OF LEGENDS:	One Both None
NUMBER OF GOLD EDGES:	1 2
NUMBER OF GOLD FINGERS:
GOLD THICKNESS:	None 30-50 MICROINCHES 50-75 MICROINCHES
ELECTRIC TEST:	Yes No
NUMBER OF SMT SIDES:	One Both None
SMALLEST SMT PITCH:
# OF SMT PADS:
LEAD TIME:	Standard-3 weeks All-Quick Turn plus Standard 24 Hours 2 Days 3 Days 1 week 2 week 3 week

OTHER REQUIREMENTS:
Attachment: