QUALITY - RELIABILITY - EFFICIENCY

Sample Request Form (Application Information)

* = Required information
Company: *
Street Address: *
City: *
State/prov.: *
Zip: *
Country: *
Requested By: *
Title:
Fax:
Phone: *
E-mail: *
Application:

APPLICATION DESCRIPTION/DETAILS

Application Is:
New Product    |    Existing Product

Thermostat Function:
Temperature Control
Over Temperature Protector
Temperature Sensor
Over-Current Protector

Electrical Requirements:
Applied Voltage
AC    |    DC

Electrical Load

Amperes    |    Watts
Resistive    |    Inductive

Thermostat Specifications:
Contacts Open Circuit on Temperature Rise (Normally Closed)
Contacts Close Circuit on Temperature Rise (Normally Open)

Calibration Temperature Required
°C±    °C Tolerance
Reset Temperature Desired
°C
Please give temperatures in Celsius. To convert from °F, Click Here

Lead Wires: Length Required (in Inches)
Lead#1

Lead#2

Wire Gauge

Insulation Type

Thermostat Insulating Sleeve:
Mylar
Nomex
Other
None Required

Thermostat/Thermal Protector Models:


Samples:
Pieces Required:

Date Required:


Production:
Estimated Annual Usage

Quotation Required
If Yes, Quantity: