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Request A Price

This checklist was created in order to expedite quotes in a timely manner. Please fill out the top part of this form and either the Assembly and/or the PCB section completely to help expedite your request. Thank you for your help, and we appreciate your interest in G.I.C.

Company Name
Company Address
Company Phone Number (please include area code)
Company Quote Number
Contact Name
Contact Phone Number (please include area code)
Quoting quantity(s):          
Requested completion
date for quote:		 (mm/dd/yy)


Assembly Checklist
Please fill in all information that applies.
Assembly Part Number  
Revision Level  
Budgetary quote?   Production quote?   Turnkey?   Consignment?
Pricing Target   $   For quantity of
Surface Mount   Through Hole   Mixed Technology
A detailed Bill of Material is required to perform a valid quotation.
Please check the following as verification of necessary component specifications:

Component Prints   Component Manufacturer   Manufacturer Part Number   Part Description

Quantity of each Component   Component Package   Component Tolerance   Lead Spacing
If there are Components on both sides of the PCB, does the Bill of Material clearly identify components that are on the Solder side of the PCB?
Yes   No
If No, please identify components that are on the Solder side of the PCB:
If the job will be Consignment, what will be supplied by customer?
All Parts   Certain Parts   PCB's
If the customer is supplying parts, are they clearly marked on the Bill of Material?
Yes   No
If No, please list parts that are customer supplied:
Is Testing required?
Yes   No
If yes, please select any of the following that apply:
Functional   Burn-in   In-Curcuit
Are Testing fixtures currently available?
Yes   No
If No, will G.I.C. be required to quote the development of testing fixtures?
Yes   No
Which will you be providing for this quotation?
Functional Test Procedures, or
An estimated Functional Test Time       Time in Minutes
Special Assembly Notes or Instructions
Will you be providing a complete assembly sample for this quotation?   Yes   No
If you want us to include the Bare PCB for this quotation, please complete the PCB Checklist below.


PCB Checklist
Please fill in all information that applies.
Bare PCB Part Number  
Revision Level  
Pricing Target   $   For quantity of
Please check which data will be provided for quotation:
Gerber     Prints   (some of the information below may not apply)
Sample   Photo plots/artwork   (please be sure fill in all information below that applies)
Board size in inches   Height "   Width "
Rectangular in shape?   Yes   No
Material:

- Cladding: Single-sided   Double-sided   Multi-layer  
If Multi-layer, number of layers:

- Thickeness: .062   .031   .093   - Other:

- Type: FR4   CEM   - Other:

- Ounces Copper: 1/2   1   2   - Other:
Mask: Solder Side   Component Side   LPI   - Color:
Legend: 1 side   2 sides   - Color:
Selective Gold Gold Fingers       Number of fingers:
Slots Cutouts       Number:
Carbon Ink?     Yes   No
Electrical test?   Yes   No
Special PCB Notes or Instructions

Please make sure that all supporting documentation is sent to us for review at this email address info@gicltd.com, or to our mailing address:

Graphics and Industrial Circuits, Ltd.
100 North Sixth Street
Kirkland, IL 60146

This supporting documentation could include Bill of Material, Component prints, Assembly prints, Completed sample, Test Specifications, Packaging information, Bare PCB data.


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