Company:

Contact Name: Title: Email:

Phone: Fax: Web Site:

Used In: Existing Device/Product (Description):

Existing Battery in Use (Chemistry, Voltage, Capacity, etc):

Specification Required: (Mil-Spec, Regulatory, etc):

Voltage: Min Max Typical CutOff

Drain: Constant Resistance Constant Current: Min Max

Typical: Standby Drain:

Pulse: Peak Current: Pulse Duration (s/ms):

Pulse: Interval: one pulse per: ms s mins hrs days years

                                                         T(on)   T(off)

Pulse Cycle (if there are pulse cycles of different pulse, please describe):

Duration: month's year's operation life: (mins/hrs/days/etc)

Storage Minimum: °C Typical: °C Maximum: °C

Operation Minimum: °C Typical: °C Maximum: °C

Estimate Annual Volume: Order Schedule:

Sample Requirements (Q'ty): Requirement Date:

Terminals (type) Brand: Model: Wire Leads (gauge, length):

Custom (Specify):

Other Requirements:

Your sample request will be confirmed by the end of the next business day. You will also receive a copy of the sampe request. If you do not receive confirmation or a copy of the request, please re-submit your request.