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Company Info:

Company Name
Address
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Your Name Title Phone Ext.
Purchase Auth. Name Title Phone Ext.
Project Name email
Phone Number FAX Number

Existing Part Cross New Requirement
Part Number Manufacturer
Linear Switcher DC/DC Other:

Outputs:

	Volts	x	(Min. Amps)	(Nominal Amps)	(Peak Amps)	=	Watts
1.
2.
3.
4.
5.

Input Size Total Power:

Safety Approvals:
UL CSA BABT VDE TUV Other:

FCC/VDE for EMI:
Temperature Rating:
Regulation Requirements:

Special Features/Comments:

Prototype Target Date: Production Target Date:
Estimated Annual Usage: Target Price:

Additional Items Required:
Filters Surge Arresters Value Added Other

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