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CUSTOMER DATA
Customer / Company Name:*
Customer Contact:*
Position:
ELECTRICAL DATA
Nominal Pack Voltage:
Minimum Capacity:
Chemistry (NiCd, NiMH, SLA, Alk):
MECHANICAL DATA
Number of Cells:
Cell Size:
Safety Devices (Thermistors, Thermal Switch, PTC, etc.):
"L" or "F" Type:
Not Sure
L
F
Heat Shrink, Tape, Hot Melt, Glue?:
Output Connector:
Wire Gauge:
Wire Length:
Other:
Dimensions:
Length:
Width:
Height:
APPLICATION DATA
Estimated Annual Usage:
Target Price:
Application:
New Application or Replacing Current Pack:
Not Sure
New
Replacement
Can Customer Provide Sample?:
Not Sure
Yes
No
Customer Requires Sample?:
Not Sure
Yes
No
Required Date:
Customer Requires Quotation?:
Not Sure
Yes
No
Required Date:
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