Fill in the fields with as much information known as possible, and press the submit button at the end of this form to mail it to the sales department. If this is a rush delivery, contact the sales department at (973)284-1600. Customer Information

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PART INFO FOR PCB ASSEMBLY
Part Name/Part Number:
Revision:
Number of Board(s) to Quote:
Quote Type	Consignment Turnkey Other
Technology	Through Hole Surface Mount Mixed
Surface Mount on	One Side Both sides No Surface Mount
Required Testing Type	Functional - Customer to supply test Fixture In Circuit No Testing required
Conformal Coating	Yes No
Additional Items required	BOM with Part Specs & Manufacturer's name, Assembly Drawings

Other Requirements:

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