Price Quotation Form

Please provide the following:

          Name: 
       Company: 
       Address: 
City/State/Zip: 
       Country: 
         Phone: 
         Email: 
           Fax: 

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   Part Number: 
      Material: ---Please choose from below---FR-4CEM-1Other

       Mil. Spec 55110/IPC 4101

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      No. of Layers: 
  Overall Thickness: ---Please choose from below---.031.062.093Other   

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      No. of Holes: 
          Smallest: 
           Largest: 

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          Board Width: 
         Board Length: 
     No. of Top SMT Pads: 
  No. of Bottom SMT Pads: 
           Trace / Space: ---Please choose from below---.006.008.010Other
               SMT Pitch: ---Please choose from below---12 mil16 mil20 mil25 mil50 milOther 

                                Individual:
                                   Paletted:
 Number of Palettes per Board:
                           Palette Width:
                     Palette Length:

Method of Seperation

                 Break-away: 
                    Scoring: 
Combination of BA - Scoring: 

Solder Mask Type:

                   Screened: 
       Liquid Photoimagable: 
                      Other: 

Silk Screen

                    One-Sided: 
                    Two-Sided: 
                         None: 

Select from the Following

        Hot air Level (SMOBC): 
    Entek (Organic Protecton): 

Please Check the Applicable box:

Control Impendance
Gold Fingers
        Number of Fingers per Side:
Plugged via
Buried via
Blind via
Class 3
Electrical Test
Fabrication Info: Gerber Files
Film Positive / Negative

Please List the Requested QTY & Lead-Time (in # of working days)

QTY:

Lead Time:

QTY:

Lead Time:
		
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