Contact Information

First Name

Last Name

*Email Address

Street Address

City State Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut District of Columbia Delaware Flordia Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other Zip

Phone

Fax

Assembly Name:

Assembly No.:

Rev.:

Quality Level (IPC Class 2 or 3)

Quantities needed

Lead times (business days) or due dates

PCB Length (inches)

PCB Width (inches)

# pcbs on array-optional

Array Length (inches-optional)

Array Width (inches-optional)

Surface Mount Assembly

# Passive Components

# ICs

Total SMT Components

Smallest size passives

Finest pitch SMD (inches)

Finest pitch BGA (mm)

# SOIC's (SO8 - SO16)

# SOLIC's, PLCC's

# Fine Pitch (.010" - .020")

PTH Assembly

Integrated Circuit (DIPS)

Axial Components

Radial Components

Connectors

Total PTH Components

Total Number of Components

Jumpers

Etch Cuts & Soldermask

Mechanical Assembly

# Screws

# Rivets

# Terminals

# Mechanical Jumpers

# Connector Pins (press-fit)

# EPROM Installation

Adhesive Bonding
(Y or N)

Rubber Stamp Marking (per application)

Conformal Coat (Spray-2 sides) (Y or N)

Comments