Company Name:

Name of Contact Person:       Title:

Street Address:

City:     State:     Zip:

If Different From the Street Address: Mailing Address: City:     State:     Zip:

Office Phone:     Fax:

Home Phone:

E-Mail Address:

Web Site URL:

PCB Design Quote Information

Board Name:

Board Number:

Board Size:

Layer Count (if known):

Part Count:

Pin Count:

Desired Delivery:

Board Technology: Surface Mount   Through Hole   Mixed   BGA

Special Routing: Yes   No

Controlled Impedance: Yes   No

Special Placement: Yes   No

CAD Netlist Available: Yes   No
Which CAD Format:

If you are not sure of the pin/part count you can also e-mail or fax us your BOM and or your schematics. A DXF format is preferred for the schematic files. Please contact us directly for Fabrication and Assembly quotes.

Comments/Suggestions/Requests: