Click for help in filling out this form...
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Adapter Type:
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| Complete this section for Desk-Top requirements only: |
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Inlet Receptacle: |
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Quote on the input cord?
yes
no |
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Input Cord: |
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Continue for both Wall-Mount and Desk-Tops:
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Input Voltage (AC):
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Output (DC):
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DC |
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Output Voltage:
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Output Current (mA or A):
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Output Regulation:
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Regulated |
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Output Cord:
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Output Plug Length:
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| Output Plug Polarity: |
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| Ambient Temperature: |
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| Safety Agency Approvals: |
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| Additional Notes: |
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Quantities to quote:
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1k pcs |
2.5k pcs |
5k pcs |
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10k pcs |
25k pcs |
50k pcs |
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| Other quantites: |
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| Project Name: |
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| Quote FOB Point: |
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Please advise where we should send the quote...
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| First Name: |
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| Last Name: |
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| Company: |
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| Email: |
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| Telephone: |
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| Fax: |
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| Position: |
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| Street Address: |
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| City: |
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| State: |
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| Country: |
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| Postal Zip Code: |
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