Quote Info Form

Company:                

Address:                

City:                   

State:         Zip:           

Date:                   

Your Name:   

Department:    

Telephone:     Ext.  

Fax:           E-mail: 

  Program Information

1. Estimated Annual Volume:  

Samples Required:             Yes     No
Prints  Required:             Yes     No

2. Release Quantities:        

                Target Price      Program Life 

  Specifications

Attached:          Print    Sketch        Part Number   

1. Terminal:       Strip    Loose Piece 

Approvals:         UL       CSA           Other Approval 

2. Material:
   Metal    Thickness    Plating  

3. Electrical:
   Current    Voltage   Resistive    Cycles 

4. Environment:      Temperature     Testing    Cycles  

5. Housing:      Yes (please send samples)   No     Material 

6. Packaging:    Reel Size    Reel Weight    Pallet Size  

  Wire

Gauge      Type       Solid    Stranded 

Number Strands      Insulation Diameter     

  Attaching Equipment

1. Applicator Type:      ECC         Mini       Die Set        Other 

2. Press Type: 
   Name    Model    Type 

3. Cam Used:             Upstroke    Downstroke      Stroke Length 

4. Automated Wire Processing Equipment:
   Name    Model 

5. Pull Test Requirement:  UL                CSA              Other 

6. Feed Direction:         Left to Right     Right to Left     From Rear

7. Crimp Specifications:
(If special crimp 
specifications are 
required, please fill in
the diagram to the right.)