To insure a high level of satisfaction, we have developed this form for current & potential clients. Below are listed the mailing address, direct telephone extentions and a contact form. Feel free to contact us whichever way that is more convenient for you.

Full Name:			Title / Position:
Company Name:			Mailing Address:
City:			State:	ZIP:
E-Mail:			Telephone:	Ext:
Fax:			Company Website:

Input Requirements
Alternating	90 - 132 V	180 - 264 V	90 - 264 V
	50 Hz	60 Hz
	EMI: EN 55022	Class A	Class B
Direct	Nominal      Range
	Filtering Required Yes No Not Sure
	Isolation (VDC)

Output Requirements
	Voltage	Current (A) Type	Max	Peak	Regulation % Line	Load	Ripple & Noise	OVP
Voltage 1
Voltage 2
Voltage 3

General Requirements
Continuous Output Power Watts	Efficiency %	Operating Temp (° F)

Method of Cooling	Free-Air Convection     Forced Air      If other method is used, please specify
Dimensions	Inches Millimeters      L × W × H
Power Density	Watts / Inch3

Additional Requirements

Projected Qty:		Price Objective: $	(usd)
Prototype Qty:		Prototype Date:	(mm/dd/yyyy)

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