Customer Order/Quote Request/Sample Request

Date	07/27/2004	Delivery Date
Name
Address
Address
Address
City
State/Province		ZIP/Postal Code
Phone		Fax
Contact
Notes

Order Quotation Sample Request
Part Number		Layout (e.g., 4 x 3 = 12 cell)
Quantity		Board caliper (thickness)
Number of cells		Board type

Partitions

	Short strip dimensions:
		Number of slots:
		A (cell size):
		B (height):
		C (length):
		D (air cell - optional):
	How many strips?

	Long strip dimensions:
		Number of slots:
		AA (cell size):
		BB (height):
		CC (length):
	How many strips?

	Special Features:		Air cells/buffers Arrows Boxed Corner cuts Easy-grip®/Cleve-Grip® Glued end cell Indexing Other Pallets Printing V-notches

Pads

	Dimensions:
		A (width)
		B (length)