Online Design Form - FMA 16-ch (18 elec. total) (STD/HD)

Fields marked with (*) are required

Contact Information

Enter Contact Person’s Name.
Enter a valid email.
Enter a valid phone number
Enter your Institution name.
Enter the Street, City, State, and Zip Code (If apply).
Enter Principal Investigator’s name.
Please type Name on Quote (if not contact person)

GENERAL SPECIFICATIONS

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A number is required.
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Please attach description of desired configuration to the Custom Design and Layout Sheet entry below. If different types or layouts of array are desired within the same combo implant, please submit a different design form for each and add explanation to Custom Design and Layout Sheet.
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A number is required.

Array Impedance, Length, and Pin-Out Mapping

Assign pin location according to your system

FMA Hole# Pin # Impedance(MΩ) Length (mm)
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2
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3
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4
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5
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6
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7
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8
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9
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10
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11
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12
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13
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14
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15
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16
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17
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Accessories and Additional Services

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Your custom design and layout sheet

If your requested design cannot be fully described by the questions above, please attach a description here. Make drawing as clear as possible:

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Application Description (Optional)

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About Your Order

Numeric Value
See Terms and Conditions for details
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Functional channel count of delivered product may be 10% lower than indicated channel count. Please see Terms and Conditions.

If you will like to discuss any other technical aspect of your design please contact us via email at support@microprobes.com Thank you!

QMF 38 - Digital version - Master with QMS representative
Revision 01-042720