| Salutation: |
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| First Name(s): |
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| Last Name: |
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| Job Title / Departement: |
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| Company: |
(required, if private - please
write
"PRIVATE") |
| Street / P.O. Box: |
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| |
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| City: |
State:
Zip: |
| Country: |
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| Phone Number: |
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| 2nd Number: |
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| FAX Number: |
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| Email Address: |
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| Subject / Interest: |
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| |
(required, e.g.
DC/DC Converter SDC144.1) |
| |
|
| Quantity needed: |
(e.g. 250 units per year) |
| Project Schedule: |
(e.g. in 1 week 3 prototypes
needed,
then 20 units per week) |
| Application: |
|
| |
(e.g. power-supply
for radio on a forklift truck) |
| |
|
Input
Voltage Range: |
(e.g. 16 to 36VDC) |
Output Voltage(s)
and Current(s): |
|
| |
(e.g. 12.5VDC /
12A max.) |
| |
|
| Galvanic Isolation |
between Input and Output |
| |
|
| Letter / Comments: |
|
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| |
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| |
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