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 DesignRe DesignExisting Design

Do you have a drawing?   SelectYesNo

Do you have a sample?  SelectYesNo

Specifications:

Touch Screen Type: Select4-Wire8-WireX-Y MatrixCapacitive

Active Area:
(Length and Width):

External Dimension
(Length and Width):

Circuit Tail length: 

Tail Exit Point:
  SelectTopBottomLeftRight

Tail Termination: SelectConnectorExposed Conductors (ZIF)

Number of Tail Positions: 

Support Backer: SelectStandard GlassStrengthened GlassOther

Thickness: 

Number of Colors: 

Graphic Layer:  SelectNonePolyesterPolycarbonateOther

Shielding: SelectNoneITOOther

Additional Requirements: