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Custom RFQ

 

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Custom RFQ

Custom Adapter "Request for Quote" form

Please fill out the following form, or download an Adobe PDF version that can be faxed to us to request a quote on one of our Custom Wall-Mount Adapters. Currently we require a minimum of between 250 to 1,000 pieces on shipments of custom units.

 

   Name (first last):  
   Company Name:  
   Position:  
   Street Address:  
   City, State Zip:  
   Country:  
   Telephone #:  
   Fax#:  
   Email Address:  
   Project Name:  
We have listed common parameters in the following drop-down menus. However, if a menu does not list the option that you require, please use the "notes" section at the bottom of the page for your specifications that were not listed.
  Adapter Type:
  Input Prongs:
  AC Input:
  Output Type:
  Output Ratings:
Output Output Load Regulation Ripple
Number Voltage Current Line% Load% P-P
#1
#2
#3
  Output Cord:
  Output Plug:
  Plug Length:
  Plug Polarity:
  Ambient Temp:
  Safety Agency:


     Quantities to quote (check all needed):
     250 pcs   500 pcs  1,000 pcs
     2,500 pcs   5,000 pcs  10,000 pcs
     25,000 pcs  50,000 pcs  100,000 pcs

     Please quote back via: Email Telephone Fax

     Provide additional notes below:

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