Lorac Design - Interactive Info Request and Data Exchange Form


Name:
E-Mail:
Company Name:
Phone:
Fax:
Address:

City:
State:	ZipCode:
Country:
Provide Quote for:	Layout Fabrication Assembly Quote Due:

Board Information:
Board Name:		Board P/N:
No. of Pin Connections:		Revision:
No. of Components:		No. of Nets:
Will you provide a BOM: Yes No
Will you provide a set of Schematics: Yes No
Will you provide a Netlist: Yes No
Will you provide a Suggested Placement: Yes No
Are special design guidelines required: Yes No
Are test pads required:
Preferred Database Type:
Board Size: x
*Please provide a drawing of the outline shape with dimensions if it is irregular*
Component types:
Requested No. of Layers:
Click on all that apply:	High Speed Digital Digital Controlled Impedance Flex/Rigid Flex Matched Line Lengths Mil-Std-xxx	MCM Analog Differential Pairs RF PCMCIA PC-104	PCI Buss 8 Bit PC Buss 16 Bit PC Buss Blind / Burried Vias BGA Packages
Please check all the deliverables that you would like to see:
Check Prints in Acrobat PDF format Gerber/Drill Files Positive Photo Plots (Artwork) set(s) Negative Photo Plots (Artwork) set(s)		Fab Drawing Assembly Drawing BOM CAM Files Archive Set

Fabrication (only required if a fabrication quote is requested)
Quantity of boards to be manufactured:	Requested turn around time:
Board Thickness: Other:
Copper Thickness - Outer Layers:	Copper Thickness - Inner Layers:
Silk Screen Legend: Solder Mask:
Board Material: Other: Test:
Board Plating: UL:
Controlled Impedance: Yes No
Tented Vias: Yes No
No. of holes: No. of holes >.156 No. of holes <.023

Assembly (required only for assembly quote)
Will you supply all parts: Yes No
Quantity of Boards to be assembled:	Requested turn around time:
Are any components to be socketed: Yes No
For an assembly quote, please submit your bill of materials to us via our FTP upload, FAX or E-Mail .
Additional Comments: