AMPEL Quote Request Form - Printed circuit boards prototypes to production

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Company Name:

Contact Name:

Street Name:

City Name:

State:

Zip Code:

Phone Number:

Fax Number:

Email Address:

Part Number:

Required Bd Quantities:

Delivery (wks or dys):

Job Type:

** If revision please list changes.

Bd. type:

# of Layers:

Material:

Thickness:

Bd. Dim X:

Array X:

# up:

Score

Rout

Finished Copper (Outer Layers):

Finished Copper (Inner Layers):

Min. Circuit:

Min. Space:

Hole Qty.:

Smallest:

Solder Mask:

Color:

Type:

Legend:

Color:

Final Finish:

Gold tabs:

Yes

Electrical Test Required:

SMD Pads:

# of Pads Side 1:

# of Pads Side 2:

# of Carbon Pads:

IPC Class:

Vias Plugged

Controlled Impedance

Information Provided:

Please enter any additional information or comments: