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* Name:
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* Company:
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Address:
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* Phone:
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Fax:
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* email:
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Prototype quantity to be quoted (specify
a range if needed):
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Production quantity to be quoted (specify
a range if needed):
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Annual ordering pattern:
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Not sure
Once a year
Every 6 months
Every 3 months
Every month
Other, please specify:
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Are you interested in hearing about our Just-In-Time
option?:
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yes
no
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How will artwork be provided:
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Electronic artwork (preferred)(e.g. email, CD, diskette,
zip drive)
Drawing
Camera ready print
Film negative or positive
Sample
Other, please specify:
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Mounting Surface Texture:
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smooth
textured
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Options selected:
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Backlighting
Shielding
Bezel
Plastic keys
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SPECIFICATIONS (if known):
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Number of keys:
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Key Travel (if known):
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Number of actuations:
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Circuit resistance:
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Actuation force:
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Tactile Ratio:
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Contact Force:
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Contact bounce time:
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Dielectric withstand voltage:
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Insulation resistance:
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Capacitance:
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Current carrying capacity:
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ESD:
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Atmospheric pressure:
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Contact closure cycles:
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Operating temp & humidity:
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Storage temp & humidity:
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GRAPHIC OVERLAY (toplayer):
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Size (specify unit of measure): Width X Height:
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Specify material if known
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Unknown
Polyester
Polycarbonate
Elastomer
No graphic layer
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Specify material thickness, if known (e.g.
.005", .007, etc):
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Surface texture of material, if known:
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Unknown
All gloss
All textured
Both gloss and texture
Other, please specify:
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Embossing:
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None
Border
Pad
Dome
LED
Other, please specify:
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What are the colors of the copy and graphics
on your overlay or panel?:
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Do you need 4-color process printing (e.g.
for a complex graphic)?:
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yes
no
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What is the background color?:
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Number of transparent lens colors?:
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ELASTOMER KEYPAD (optional layer):
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# of mold colors:
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# of legend colors:
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# of clear coats on legends:
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Keytop durometer (shore): (optional):
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Laser etched legends:
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yes
no
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MEMBRANE LAYER (required layer)
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polyester, opaque conductor
polyester, transparent conductor
metal dome, metal conductor
elastomer, conductive pill
poly-graphic layer, opaque conductor
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TACTILE LAYER (optional layer)
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metal dome
poly dome
graphic dome
packaged membrane
elastomer
non-tactile
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STATIC LAYER (required layer)
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Polyester, opaque conductor
Polyester, transparent conductor
Polyimide, copper conductor
PCB, copper conductor
Packaged membrane, internal conductor
Glass, transparent conductor
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RIGID LAYER (optional layer)
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Aluminum
Steel
Plastic
Glass
No rigid backer
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TAIL:
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Include a flex tail?:
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yes
no
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Length of tail (if applicable):
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Tail Connector needed:
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yes
no
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Tail Connector-if yes
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None
Male
Female
Solder tabs
Zif
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Location of tail (describe):
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PRINTED CIRCUIT BOARD (if applicable):
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Thickness:
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Number of pins on header:
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Type of header:
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straight
90 degree
single row
double row
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MOUNTING FASTENERS:
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Fasteners 1 (optional) : Qty:
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Fasteners 1(optionai)? Type: (ie. Stud or
standoff, dia, thread type):
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Fasteners 2 (optional): Qty:
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Fasteners 2 (optional): Type: (ie. Stud or
standoff, dia, thread type):
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Fasteners 3 (optional): Qty:
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Fasteners 3 (optional): Type: (ie. Stud or
standoff, dia, thread type):
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Fasteners 4 (optional): Qty:
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Fasteners 4 (optional): Type: (ie. Stud or
standoff, dia, thread type):
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LED BACKLIGHTING (optional):
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Color red quantity:
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Color green quantity:
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Color yellow quantity:
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Color blue quantity:
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FIBER OPTIC BACKLIGHTING (optional):
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Length of tail bundle:
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Light source:
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LED
Halogen
Vacuum
Fluorescent
Gas
Other, Specify:
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Voltage available:
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VAC
Hz
VDC
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EL BACKLIGHTING (optional):
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Length of flex tail:
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Color:
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white
blue
blue-green
Other, please specify:
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Connector:
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yes
no
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Connector-if yes
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None
Male
Female
Solder tabs
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# of independently lit areas:
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TOUCH SCREEN (optional):
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Largest dimension: _X_:
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Digital: # of rows:
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Digital: # of columns:
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Analog: Linearity:
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3%
4%
5%
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Nema 4: does this panel have to meet Nema
4 water tight construction from the edges?:
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yes
no
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Do you need these membrane switches earlier
than the normal 20 working day leadtime?:
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yes
no
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Lead time: If yes, please specify when you
need the overlays or panels:
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Comments or additional information:
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Would you like to receive Melrose samples?:
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yes
no
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