Contact Information
Company Name: Address #1:
Phone Number: Address #2:
Fax Number: City:
Purchasing Contact: Extension:
Engineering Contact: Extension:
State/Province/Zip/Postal Code: Email Address:
Part Number / Name: Revision:
You may enter up to (3) different quantity and delivery options.
Quantity: (1):  (2):  (3): 
Delivery Required(weeks / days): (1):  (2):  (3): 
Job Status... New Job: Reorder: New Revision:
NOTE: If Reorder; please only provide the information that has changed.
Board Type.... SS: DS: ML: Number of Layers:
Board Dimension: X:   Y:  
Material Type: FR4: Other:
Material Thickness:
Copper Weight in oz. [Outer Layer] H: 1: 2: Other:
Copper Weight in oz. [Inner Layer] H: 1: 2: Other:
Certification. U.L. Logo Required: Certificate of Compliance:
Circuitry. Minimum Width:   mils. Minimum Spacing: mils.
Holes. Quantity: Number of Sizes
Smallest Hole Size: mils.
Vias.Blind - Quantity: Buried - Quantity:  
Panel Routing. Yes: No:
Routed Panel Size.X:    Y:
Solder Mask. None: 1 Side: 2 Sides:
Color: Green:  Other:
Mask Type. LPISM:  Other:
Silkscreen (Legend). None: 1 Side: 2 Sides:
Color. White:  Other:
Final Plating. Tin/Lead:  Solder Levelling(SMOBC):  Bare Copper:  Gold: 
Gold Tabs. None:  Yes: Number of Edges:
Electrical Test. No: Yes:
Number of Holes to be tested: Minimum Spacing:
Surface Mount Pads. No:  Yes: 
Number of Pads.Side-1: Minimum Spacing (pitch):
Photoplotting. No: Yes: Number of Plots:
Photo Reduction. No: Yes: Quantity:
You will provide. Gerber Files: Drill File: 1:1 Artwork: 2:1 Artwork:
Note: We prefer Gerber Files with Aperture List and Drill File.
Please note any special requirements in the text area provided below:
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