Relay Application Questionnaire
Engineer's Name
Company
Address line 1
Address line 2
City
State/Province
ZIP
Phone
FAX
E-Mail
Buyer's Name
Address line 1
Address line 2
City
State/Province
ZIP
Phone
FAX
E-Mail
Present Need Development
  OEM
  Internal Use
Second Source? Yes
  No
 
Present Relay Vendor/Part Number
Replacement? Yes
  No
 
Why?
Equipment and/or Service for Which Relays are Needed
Quantity Needed
  Per Year
Delivery Requirements
Pricing Requirements
Coil Input Pickup or Operate
  Dropout or Release
  Volts
  Milliamps
Coil Resistance
Coil Inductance at Hz
Coil Power Normally On
  Off
Duty Cycle On %
  Off %
  Max. On Time
Maximum Coil Overload Watts
Speed and/or Life
Switch Form SPDT
  SPST
  Other
Contact #1 Load
MA at Volts AC Resistive
  DC Inductive
Contact #2 Load
MA at Volts AC Resistive
  DC Inductive
What is the load?
Temperature Range
Vibration
Shock
Special Requirements
Environment
Mounting, Marking, Style
Special Flux
Flux Removing Agent
Special Customer Required Switch
Is Relay New Design
Modification of Existing Relay
 
Circuit Drawing: Coil & Load Circuits, With Characteristics and Any Other Pertinent Details. (please FAX or mail any drawings)
Contents
 
More Information
  Literature
Custom Designs
  Distributors
CHECK OUT OUR LINE OF HIGH VOLTAGE RELAYS.
 
Standard Terms: Check/Money Order
Net 30
Credit Card
Minimum Order: $100.00
Wholesale/OEM
Master Card Visa
American Express Discover
 
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