Contact Information
First Name
Last Name
Title
Organization
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Work Phone
FAX
E-mail
Quote Information
Annual Usage
Timing / Delivery
Target Price
Electrical and Mechanical Description
Transformer / Inductor Type
Operating Frequency
Operating Mode (i.e. Flyback, Bridge, Push-Pull, etc.)
System Application (Market)
Ambient Temperature Range
Inputs (Volts and Amps)
Outputs (Volts and Amps)
Voltage Dielectric Requirement
Termination Type (Pin Mount, Surface Mount, Leads)
Critical Size Limitations (Height), Width, Length)
UL Temperature Class (130, 155, 180C)
Agency Requirements (UL/VDE/CSA)
Additional Electrical and Mechanical Requirements