Design Inquiry Form - Power Products Customer Time Line (fill in dates) Question Title * Quotation Date / Time Date Question Title * Prototype Date / Time Date Question Title * First Article Date / Time Date Question Title * Production Start Up Date / Time Date Question Title * Product Offer Suggested for this Application Custom Assembly (Designed to meet your specific requirements) Power Entry Filter (Lower Cost Commercial Application) High Current Single/Dual Line Feed Through Filter Physical Parameters Question Title * Mechanical RequirementsMaximum Dimensions (Inches) Length Height Width Maximum Weight Question Title * Please include a drawing or sketch, if available PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only. Choose File Choose File No file chosen Remove File Please include a drawing or sketch, if available Electrical Parameters Question Title * Electrical Terminations - Line Side Connector Studs Pigtail Leads Terminal Block Other Question Title * Electrical Terminations - Load Side Connector Studs Pigtail Leads Terminal Block Other Question Title * AC Requirements 120VAC 250VAC Other (please specify) Question Title * Frequency (Hz) 50 60 400 Other (please specify) Current (amps) Question Title * AC Current/Phase (amps) Question Title * AC Phase requirement Single Three Delta (3 wires) Wye (4 wires) Other (please specify) Question Title * Leakage Current (mA Max. At nominal AC voltage and frequency) Question Title * DC Requirements 28 VDC 270 VDC Other (please specify) Question Title * Current (amps) Question Title * Number of DC circuits to be filtered Question Title * Insertion Loss Requirements Load No Load Common Mode Common Mode Load Common Mode No Load Differential Mode Differential Mode Load Differential Mode No Load Question Title * Insertion Loss Requirements - Min Frequency (MHz) Common Mode Differential Mode Question Title * Insertion Loss Requirements - Min I.L. (dB) Common Mode Differential Mode Accessories Question Title * Surge Suppression Yes No Define Question Title * Circuit Breaker Yes No Question Title * Current Rating Question Title * Voltage Rating Question Title * Vendor Question Title * P/N Question Title * Switches Lighted Non-Lighted Remote None Question Title * Agency Approvals UL CE CSA TUV Other (please specify) Question Title * Contact Information Name * Company * Address Address 2 City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Country Email Address * Phone Number Question Title * Target Price Question Title * Anticipated Year Usage Question Title * Life of Program Done