Assembly Quote Request Form

Customer Info

Company Name*:   
Contact Name*: Title*:
Street Address:
City* State* Zip*:
Telephone*: Fax*:
E-mail*: URL:

Order Info

Part Number*: Revision:
Quantities*:
Delivery Requirement*:

Bill of materials

Please list all thru-hole part numbers and quanities
Please list all surface mount pad part numbers and quanities. Please read our requirements for SMT and contact us if you have any questions or concerns.
Mil-specs Testing
If you have already prepared as bill of materials in Microsoft Word or Excel we would prefer that format. You can upload it to the incoming folder in our anonymous FTP.

Special Requirements:

If testing is required please describe the testing process including time and if a special fixture is required.

Asterisks denote required fields, your quote will not go through if you do not complete them.
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