Roca Printed Circuits 12830 Century Drive - Stafford, Texas 77477 PH: 281-240-8140 FAX: 281-240-0557 Email: sales@rocaprintedcircuits.com
Order Entry
Company Name*
Purchase Order Number*
Company Shipping Address*
City*
State, Zip* N/A AL AK AR AZ CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY ,
Company Billing Address(if different from shipping address)
State, Zip* N/A AL AK AR AZ CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN UT VT VA WA WV WI WY ,
Contact Phone*
FAX Number
Contact Name
Email
Order Information
Number of Boards
Description or Part or P/N
Number of Layers
Required Delivery in Business Days 3 Days 5 Days 10 days 15 days
Price (shown inside matrix box)
Extra Costs - Color Soldermask No Added Extras Red Soldermask Blue Soldermask Clear Soldermask
Amount Added $
Extra Costs - Electrical Test No Added Extras Test 2 - 10 Boards Test 12 -24 Boards
Deduct for using Tin/Lead Reflow No Deductions Sub Tin/Lead Refow for SMOBC
Amount Deducted$
Deduct for no Soldermask No Deductions No Soldermask
Amount Deducted $
SUBTOTAL $
Billing - Shipping - Credit Card Information
Credit Card Type: Visa Mastercard AMEX
Credit Card Number
Expires
Credit Card Holder Name
Current Net 30 day Client Yes No
Shipper UPS FedEx Airborne Select
Service Required Standard Ground 2nd Day Next Day
Shipping Instructions
NEED HELP? CALL 281-240-8140
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