Image Associates

Division of Image Electronics, Inc.

Sourcing Custom Fabrication and Electronic Components

to OEM & EMS manufacturers throughout North America since 1992

3625 E. Thousand Oaks Blvd., Suite 165 · Westlake Village, CA 91362
805.777.1106 Fax 805.777.1136 sales@imageassoc.com

Sorry, Response Card is temporarily out of service - please call, email or Fax

Image Associates Customer Response Card

Please take a few minutes to fill out this form so we can tailor an information package for you. You can also contact us at 805.777.1106 or by fax at 805.777.1136

General Information:
I am interested in:
Name:
Company:
Address:
City:
State/Province
Zip
Country:
Phone:
Fax:
Email:

Please send me the following information:
Sales Literature	Technical Specs
My requirement is:
Project Status:
Please contact me by:
Email	Regular Mail
FAX	Phone
Comments on site:
I am/will be working on the following:
Prototype development	Production
Quantity of Units Needed:
Size of Company:

Program Name:
Please Send Me:
Samples of Part Number:
Quantity:
Application:
Time to approve:
Estimate annual usage:
Please Send Me:
Cross Competitive Part Number:
Manufacturer:
Estimated Annual Usage:
Sample Quantity:
Questions or Comments:

Please Click on SEND when complete!

[Info] [About Image] [Lines Represented]
[Response Card]