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
 
STENCIL 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
Identification:
(will be engraved on stencil)
 
 
   
Data:
File Name:
 Laser Cut Stencil Specs:
For Printer Type:
   
Metal:  
Metal Thickness: mils
Frame Size: - Other:
Border:
Fiducials: 
Location of Pattern:
Text:
   
Identify stencil for lead free (pb free)
 
   Special Instructions or Modifications:  
   
  Email me a PDF "check plot" prior to proceeding with my stencil.
Email me a Gerber "check plot" prior to proceeding with my stencil.