1106 South High Street,  South Bend, IN    46601  USA
Phone:  574-232-4358
e-mail: info@microscreen.org  		 Fax:  574-234-7496
  www.microscreen.org
 
SCREEN ORDER FORM
Please submit this form prior to transmission of Gerber data
 

Company Name:
Engineering Contact:
Purchasing Contact:
Purchase Order Numbers:
Engineering Phone:
Purchasing Phone:
Quantity:

Billing Information:
Billing Company Name:
Billing Address:
Billing City:
Billing State:
 Zip:

 Shipping Information:
 Shipping Company Name:
 
 Shipping Address:
 
 
 Shipping City:
 
 Shipping State:
  		Zip:
 Ship Via:
 
 Shipping Account Number:
 

Corporate Credit Card:
VISA   MasterCard   American Express
Credit Card Number:
Authorized User's Name:
Expiration Date:
 
 
 
MANUFACTURING SPECIFICATIONS

Frame Size:

Cast Extruded
 
 
Frame Provided by:
MicroScreen Customer  
Type of Screen:
Covered Only Sensitized Finished
Mesh:
Mesh Count:   Wire Diameter:  
Angle:   90   45   22 1/2   Other:  

Deflection:   MicroScreen Standard   Customer Spec   mils
or
Tension:   MicroScreen Standard   Customer Spec   N/CM
For Sensitized and Finished Screens:
Emulsion Type:
 		Emulsion Buildup:
For Finished Screens:
Data: Gerber   1:1 Art   Other
Return Artwork: Yes   No    
Please Send Sketch Identifying:
Well Side
Orientation of Artwork on Screen
Alignment of Artwork on Screen