Micro Hybrid Dimensions Customer Information


Micro Hybrid Dimensions Customer Information Form
Name	First:	Last:
Position
Company
Address
City
State
Country
Email
Phone
Fax
Part Name
Part Number
For what kind of application is this part intended?
What quantities will you require?
What are the primary markets your company serves? Defense Medical Automotive Communications Aerospace Appliance Instrumentation Other
Do you require design assistance from MHD? Yes No
Please include any additional information below.
Please submit all required part drawings as attachments to info@micro-hybrid.com.

This form uses your default email program to submit a message to MHD. This form can also be printed out and faxed to 480-784-1604.

Micro Hybrid Dimensions Customer Information Form