COT Custom Nozzle Request Form

Custom Nozzle Request

Odd form solutions for any SMT Platform
- Name*
  
  First NameLast Name
- Company*
  Company Name
- E-mail*
- Phone Number
  
  Area CodePhone Number
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- OEM*
- ASM-Siemens*
- Assembleon*
- Fuji*
- Hitachi*
- Ipulse*
- Juki*
- Mirae*
- Mycronic - Mydata*
- Panasonic*
- Samsung - Hanwha*
- Universal*
- Yamaha*
- Other Head Type
  Any other head type or nozzle base not listed
- OEM Nozzle Part #
- Nozzle ID/Type
  Specify any OEM nozzle ID or Type
- Quantity Required*
  Total number of nozzles needed
- Turnaround
  How soon do you need this nozzle delivered?
- StandardShortenedExtended
- Please specify:
  length in mm
- Barcode Required
- Barcode Data
  Please specify barcode data string/text
- Description
  Please provide description of nozzle design
- Nozzle Drawing
  
  Upload a File
  PDF, CAD, DWG, DXF, JPG, etc. Cancelof
- Component Name*
- Component Part #*
- MFG/Supplier
- Package Type*
- Other Package Type
- Component Samples*
  Are samples of the component available for vacuum testing
- Component Drawing
  
  Upload a File
  PDF, CAD, DWG, DXF, JPG, etc. Cancelof
- Special Instructions
  For component handling or nozzle design reference
- Enter the message as it's shown*
- Should be Empty: