Company Name

First name: *

Last name:*

Telephone Number:

Fax Number :

E-mail:*

Outside Dimensions: Xmm:

Ymm:

Number of keys (buttons):

Number of solid colours including background:

Number of clear LCD windows:

Number of semi-clear LED windows:

Number of semi-clear LED ports:

Number of prototypes:

Number of production:

Embossing:

Integrated LED's:

Total No integrated LED's:

EMI Shielding:

Mounting Holes:

Cutouts:

Number of Transparent Colours