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    General info

    Company Name

    Name

    Title

    Email

    Phone#

    Project name / number / revision

    Special requirements

    Assembly RFQ

    Quantity Requested

    RoHS Compliance

    YesNo

    Bare Boards provided by

    Components provided by

    IPC Class required

    123

    Other quality standard

    Layout RFQ

    Software used to create schematic

    Layout software requirement

    Number of pins

    Highest voltage

    Highest amperage

    Highest speed signal

    Signaling tech

    Density


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    732 751 2555
    5029 Industrial Road
    Farmingdale NJ 07727-3651