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  Required fields are noted with an asterisk (*).
 
Customer Information
 
  Company Name*:  
  Address*:  
  City*:  
  Country*:  
  Province / State*:  
   
  Contact Name*:  
  Email Address*:  
  Telephone*:  
  Fax:  
 
General Information
 
  Part Number:  
  Rev Level:  
   
  Quantity Required:  
Build Ship Qty EAU
   
  Delivery Required:  


 
Specifications
 
  Board Size:   x
  Assembly Panel Size:   x
   
  Fabrication:  

   
  Material Type:  



    If Other, please specify:
   
  Material Thickness:  


    If Other, please specify:
   
  Number of Layers:  










   
  Min. Line Width:  
Inner:
Outer:
   
  Min. Spacing:  
Inner:
Outer:
   
  Board Finish:  




    If Other, please specify:
   
  Solder Mask:  

Colour:
   
  Surface Mount:  


    Smallest Pitch
   
  Base Copper:  
 
1/2 oz
1 oz
2 oz
3 oz
Other
Outer Layer




Inner Layer




    If Other, please specify:
   
  Gold:  
Tips
Area Covered:
Min. Thickness:
   
  Drill Holes:  
Quantity:
Smallest Size:
Smallest Size Qty:
   
  Other Process Required:  
Buried Via
Blind Via Via Layers to
Peelable Mask
Carbon Ink
Controlled Impedence Describe Impedence Layers:
   
  Fabrication Specifications:  



    If Other, please specify:
   
  Attach Gerber Data:
Must be ZIP file of 10 MB or less.
(Attach file prior to submitting form.)