Please fill out the following form and either e-mail it to us by pressing the SUBMIT button at the bottom, or by printing it and faxing it to us at 631-842-1005.

Contact Information

Name

Company

Email

Address:

City:

State:  Zip:

Phone

Fax: 

Part Number: 

Quantities to Quote (EAU) 

Design Stage:  Select the Stage New Design Re Design Existing Design

Do you have a drawing?   Select Yes No

Do you have a sample?  Select Yes No

Specifications:

Touch Screen Type: Select 4-Wire 8-Wire X-Y Matrix Capacitive

Active Area:
(Length and Width):

External Dimension
(Length and Width):

Circuit Tail length: 

Tail Exit Point:
  Select Top Bottom Left Right

Tail Termination: Select Connector Exposed Conductors (ZIF)

Number of Tail Positions: 

Support Backer: Select Standard Glass Strengthened Glass Other

Thickness: 

Number of Colors: 

Graphic Layer:  Select None Polyester Polycarbonate Other

Shielding: Select None ITO Other

Additional Requirements: