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Customer Contact Information
Name *
Title
Email *
Phone *
Company *
Website
Project Description
Describe Application
Proto
Production
Year 1
Year 2
Year 3
Year 1
Year 2
Year 3
Existing Drawing or Specification Available
If yes, please attach a copy
Electrical Characteristics
Total Power Rating (VA)
Primary Voltage(s)
Frequency
Secondary Voltage(s) / Current
Insulation Class
Thermal Protection
Shield
Mechanical Characteristics
Minimum OD
Maximum Height
Mounting
Lead Wire Length
Environmental Characteristics
Operating Temperature Range
Humidity
UV
Vibration
Salt/Other
Agency Requirements(UL, CSA, CE, Etc)
Other Considerations
Validation *
Bicron Electronics Company
A Lean Sigma Company
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