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Registration Form
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required field
Company Name
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Customer Name
*
Address 1
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Address 2
Main Phone
Your Direct Tel. or Ext. No.
Fax #
Assembly P/N and Rev
PCB (Bare Fab) P/N and Rev
Design to Cost Goal in $$$
Build to Print Cost Goal in $$$
IPC CI 2
IPC CI 3
J-std 001 CI 2
J-std 001 CI 3
Board Size (X * Y)
Board Thickness
Panelization
Yes
No
Qty/Panel
Array
Number of Circuit Layers
Actual
Estimate
Number of Pwr or Gnd Layers
Actual
Estimate
Total Layers
Actual
Estimate
Controlled Impedance
Yes
No
Tolerance %
Solder Mask
Top
Bottom
Both
Silk Screens
Top
Bottom
Both
Total # of Holes
Total # of Hole Sizes
Surface Finish
Smallest Hole Size
Surface Finish
Surface Finish
Top
Bottom
Both
Materials will be
Turnkey including PWB
Turnkey excluding PWB
Consigned including PWB
Consigned excluding PWB
Parts List or BOM Details
Total No. of Line Items
Top Side No. of SMT Parts
Bot. Side No. of SMT Parts
Total No. of Thru Hole Parts
Are there line items to be Programmed
Yes
No
How Many
Is Conformal Coating Required
Top
Bottom
Both
Requested Delivery Time in work Days
10
5 or less
3 or less
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