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Custom RFQ

 

Custom Power Supply "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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