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Business Information
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Primary Business


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Intended Application (required)
Intended Application
Notes

Based On Catalog Standard (required)
Standard Model
Quantity(s)

Other
Notes

Exterior Appearance
(If modifications to the Standard Model's Exterior are required, please complete this section.)
Exterior Color
Please reference - Pantone Color Formula, RAL 841 GL Design System or FED-STD-595A Number
Exterior Texture
Guarded
Nameplate
Packaging
Warning Labels
Notes

Cordset Requirements
(If modifications(Add/Change/Delete) to the Standard Model's Cordset are required, please complete this section.)
Cordset
Plug
CORD
Manufacturer Name
Mfg. Item No
Gauge
No. of Conductors
Color
Length
Shield
STRAIN RELIEF
Manufacturer Name
Mfg. Item No
PLUG or CONNECTOR
Manufacturer Name
Mfg. Item No
Backshell
Connector
Terminal Type
- - - - - - - - - - -- -    Stripping plug-end (w/o plug)   - - - - - - - - - - - - -
Outer Jacket Length
Inner Lead Length
Tinned
Direct Wire Terminal Type
Notes

Testing Requirements
(If modifications to the Standard Model's Testing Requirements are required, please complete this section.)
Notes

Power Requirements
(If modifications to the Standard Model's Power Requirements are required, please note here.)
Notes

Interior Requirements
(If modifications to the Standard Model's Interior Requirements are required, please complete this section.)
# of Poles

Potentiometer
Ohms  Watts
Notes

Miscellaneous Requirements
(If modifications to the Standard Model's Certifications are required, please complete this section.)
UL Recognized Component Mark for Canada and the United States  UL Mark for Canada and the United States  DEMKO Recognized Component  TUV BAUART  SEV Accepted  CE Conformity Mark
NEMA
IP
Notes

Special Notes and Instructions
(If other modifications to the Standard Model are required, please complete this section.)
Notes