Custom Power Supply Request

Contact Name: *required

Title:

Company: *required

Address:

City:

State:

Postal Code:

Country:

Phone: *required

Fax:

Email: *required

RFQ Number:

Input Voltage Range:

Input Frequency:

Inrush Current (maximum):

Input Protection:

Hold-up Time:

Surge Protection:

Total Continuous Output Power:

Peak Power:

Safety:

UL CSA TUV Others:

Cooling:

Convection Forced Air CFM Other:

Mechanical:

Open PCB Bracket Enclosed Dimensions(mm):

Operating Temperature:

Storage Temperature:

Input Connector:

Output Connector:

Additional Requirements:

Project Quantity	Minimum	Maximum	Price Objective per Quantity Breaks
Year 1
Year 2
Year 3

Requested Prototype Date:

Production Quantity:

First Production Date:

First Production Quantity: