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PROGRAM NAME   

1. Customer Information
Date:		Call 1-888-MIL-FLEX (1-888-645-3539) (1-612-374-3021) (1-612-374-3014) FAX
Company
Address:
City:
State:      Zip:
Engineering/Program contact:
Email:
Phone:
Fax:
Extension:
M/S:
Quote Response Date by:
Purchasing contact:
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Fax:
Extension:
M/S:
2. Application Information  The following general information will assist us in suggesting the type of tooling and degree of automation required to support your application.
Annual Qty:
Monthly ship rate:
Prototype Qty:
Target price:
Production start date:
Prototypes required by: