Power Supply Quotation Request Form
	Name Project Name Company Date Required Address Quotation Quantity City Prototypes Needed By State Unit Price Target Zip Phone FAX E-mail AC Input  DC Input  Input Voltage Range  Output Voltage #1 Output Current #1 Output Voltage #2 Output Current #2 Output Voltage #3 Output Current #3 Output Voltage #4 Output Current #4 Operating Temperature Range  Desired Cooling Method  Convection Conduction Fan in Power Supply System Fan Contact Me Mounting Style  Chassis Mount Rack Mount Circuit Card Assembly VDE Card DIN Rail Rugged Mount Contact Me Size and Features Maximum Size: Connector Type: Displays: Power Factor Correction: Agency Approvals: Other:
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	Powermetrics, Inc.   749 Miner Rd.   Highland Heights, Ohio 44143 Tel: (440) 461-9352   Fax: (440) 461-9359   Email: sales@powermetrics.com © 2001 Powermetrics Inc.  All rights reserved.