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CUSTOMER NAME:   DATE:  
COMPANY NAME:     DEPT:   
TELEPHONE:                  FAX:   
EMAIL ADDRESS:   
POSITION:                  PURCHASING ENGINEERING DESIGN OTHER

PROJECT  INFORMATION
 

PART NUMBER: PART TYPE:

QUANTITY:         NEW  RE-ORDER  REVISION NO.
SERVICES REQUIRED: DESIGN LAYOUT

ALL PCBS ARE ELECTRICALLY TESTED

  PCB FABRICATION  ASSEMBLY  PARTS PROCUREMENT
DELIVERY OPTIONS:   Standard 2 Weeks   1 Week    3 Days    1 Day      Other 

PCB INFORMATION

DIMENSIONS:       LAYER COUNT:
MATERIAL:STANDARD FR4     GETEK     POLYIMIDE     BT EPOXY OTHER:
MATERIAL THICKNESS:  .062    .093    .125      OTHER:

SOLDER MASK:   LPI    COLOR:    (STANDARD-GREEN LPI)      HIGH TEMP?  YES    NO 
LEGEND:  COMPONENT SIDE    SOLDER SIDE    BOTH         COLOR:  

PLATING

OPTIONS:      SMOBC                   SMOTN            FULL BODY  GOLD        GOLD TABS          SOFT GOLD
OTHER:        

GOLD THICKNESS:    NICKEL THICKNESS: 

PARAMETERS

MINIMUM LINE WIDTH:    MINIMUM  SPACE: 
MINIMUM HOLE SIZE:        TOTAL NUMBER OF HOLES: 
NUMBER OF SURFACE MOUNT PADS:      MINIMUM PACKAGE SIZE:   
            BURIED VIAS    EPOXY PLUGGED VIAS    SILVER FILLED VIAS    COPPER FILLED VIAS

SPECIAL REQUIREMENTS:

NEED ELECTRONIC ASSEMBLY OR CABLES?