Contact Information
First name:
   
Last name:
   
Email address:
   

Facility Information
Geographic region:
   
Company name:
   
Address line 1:
   
Address line 2:
   
City:
   
State / province:
   
Country:
   
Postal code:
   

Requesting Subscriber Information
Company:
   
Contact email address:
   
Is the subscriber paying the submission fee?    Yes       No

Panel Information
Process capability panel design:
   
Copper-to-copper panel thickness (mils):
   
IPC Plating Class:    2       3
Surface finish:
   
Provide your panel design stack-up in Adobe PDF format.
   

Primary Laminate Information
Supplier:
   
Designation:
   
Tg (C):
   
IPC-4101 slash sheet designation (select the highest):
   
Was there more than one laminate material type used?    Yes*       No
           *Please provide details in the comments section below.

Through Via Information
Electroless Process:
    Supplier:
      
    Designation:
      
Electroplating Process:
    Supplier:
      
    Designation:
      
Via Fill:
   
    Supplier:
      
    Designation:
      

Blind Microvia Information    Fabricated?    Yes       No
Electroless Process:
    Supplier:
      
    Designation:
      
Electroplating Process:
    Supplier:
      
    Designation:
      
Via Fill:
   
    Supplier:
      
    Designation:
      

Buried Microvia Information    Fabricated?    Yes       No
Electroless Process:
    Supplier:
      
    Designation:
      
Electroplating Process:
    Supplier:
      
    Designation:
      
Via Fill:
   
    Supplier:
      
    Designation:
      

Buried Via Information    Fabricated?    Yes       No
Electroless Process:
    Supplier:
      
    Designation:
      
Electroplating Process:
    Supplier:
      
    Designation:
      
Via Fill:
   
    Supplier:
      
    Designation:
      

Soldermask Information
Supplier:
   
Designation:
   
Imaging method:
   

Comments
Please provide any additional information regarding this submission.

Acknowledgments
By submitting this information and the panels you are confirming that the panels were manufactured in accordance with the requirements provided with the design package.      Confirm:

Failure to provide panels not manufactured in accordance with the requirements provided with the design package may result in additional testing fees to the submitter.                     Confirm:



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