Merix

Rapid Quote Request Form:

* required fields

First Name

*

Last Name

*

Title

*

Company Name

*

Address

*

Address 2

City

*

State/Province

*

Zip/Postal Code

*

Country

*

Work Phone

*

Fax Number

Email Address

*

Sumbit Quote Via

EmailFaxPhone Follow-up

Merix Customer Service Rep (if known)

Part Number

*

Number of Layers

*

Board width (inches)

*

Board length (inches)

*

Array width (inches)

Array length (inches)

Number of boards in Array

Overall Thickness

*

Minimum Spacing

*

Minimum Trace Width

*

Material Type

*

Fabrication Type

*

Internal Cutout Quantity

Internal Slots

Plated edges or Slots

YesNo

Surface Finish

*

Gold Fingers

YesNo

Selective Plate

YesNo

Total Plated Hole Quantity

*

Smallest Plated Hole Size

*

Smallest Drilled Pad Size

Controlled Impedance

*

Blind or Buried Vias

YesNo

Epoxy Filled Vias

YesNo

Micro Vias

YesNo

Quantity		Lead-Time		General Comments
*		*

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