PRODUCT ORDERING FORM:

Contact Info:

Contact Person:_________________________________________________

Company Name:_________________________________________________

Phone Number:_________________________________________________

Fax Number:_________________________________________________

E-mail Address:_________________________________________________

Part Information:

Your Part Number:___________________________
Total Quantity: ________
New Part Number to Empire? Yes ______ No ______
New Revision? Yes ______ No ______

Board Specifications:

Number of Layers: _____
Board Size: _____ inches x ______ inches
Finish: HASL ______ E.I. ______
Surface Mount: Yes ______ No______
Side 1: _____ Side 2: ______
Minimum Pitch: ______
Number of Holes: ______
Minimum Hole Diameter: _____ inches
Minimum Trace/Space: ______

Material Specifications:

Type:
FR-4 _____ CEM-1 _____ CEM-3 _____ Rogers _____ GE Tech ______

Thickness: _____ inches
Copper Weight/Outer: _____ oz., Copper Weight/Inner: ______ oz.

Total Number of Gold Fingers: ______ Size: ______ inches x ______ inches

SolderMask:

Process Color: Standard Green ______ or
Available Color: Blue ______ Red ______ Black ______

Silkscreen: Yes ______ No ______
Color: Standard White ______ or Available Color: Yellow ______ Black ______

Specifications and testing:

Specifications: Commercial (UL) _____ Military Specifications _____
Electrical Test: Yes _____ No _____

Requested delivery:

Quantity: ________ Delivery Time: ______ (days/weeks)

Notes/Special Instructions:

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

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QC Lab
QC lab with cross section, ionic contamination,
chemical analysis, etc.