QUOTATION REQUEST                     
_____________________________________________________________________________


Company Name: _______________________ Contact Name: _________________________                               

Phone Number: ________________________ Fax Number: __________________________ 

Part Number: __________________________ Email Address: ______________________ 

Board Size _____________________ Number of Layers: __________________

TYPE: __Rigid __Flex   PLATING TYPE: __Tin __SMOBC __Gold __Other____________ 

BOARD THICKNESS: __0.031 __0.062 __0.093 __0.125 __Other_______ 

MATERIAL TYPE: __FR4 __CEM1 __Polymide __R/T Duroid __Kepton __Other_________

Copper Weight______ Number Of Holes_____  Number of Hole Sizes______

Smallest Hole Size_________ Thinnest Line Size______ Minimum Spacing _______

Gold Tabs (Y/N) __________ Controlled Impedance (Y/N) _________

Number of Gold Tabs__________ Number of Gold Tab Sides __________ 

Solder Mask (Y/N) ________ Number of Solder Mask Sides ____________

Solder Mask Type _________________ Solder Mask Color ____________________

Silk Screen (Y/N) ________ Number of Silk Screen Sides _____

Silk Screen Color ______ Number SMT Pads_____

Slot (Y/N) ______________ Slot Size _________ Scoring (Y/N) ___________

Break-away (Y/N) _____ Logo (Y/N) __________ Electrical Test (Y/N)__________   

Quantity of PCB's ___________

Turn-Around Time: ___1 Day ___2 Days ___3 Days ___4 Days ___Weekend

                  ___1 Week ___2 Weeks ___3 Weeks ___Other ____________

Special Instructions:








_____________________________________________________________________________

10650 Stancliff Road - Houston, TX 77099 - Phone: (281) 561-0802
Fax: (281) 561-0021 - www.protoline.com - E-mail: sales@protoline.com