Company Name:

Phone Number:

Fax Number:

Contact:
Extension:

Address #1:

City:

State

Zip / Postal Code:

Email Address:
*

You may enter up to (3) different quantity and delivery options.

(1) Quantity:      (weeks/days)  

(2) Quantity:      (weeks/days)

(3) Quantity:      (weeks/days)

Estimated Volume Per Year:

Board Type:      Through Hole      SMT One Side      SMT Two Sides

Board Size:      X      Y

Panelized Boards:     No      Yes      

SMT Component Size:      1206      0805     0603     0402

Components:      SMT Qty      Thru Hole Qty      Total Qty

Do you want KL Electronics to provide the Components?     No      Yes

Do you want KL Electronics to provide the P.C. Boards?     No      Yes

Please attach files:

1) Bill of Material:

2) Gerber File or Assembly Drawing:

Please note any special requirements in the text area provided below: