Custom Product Form Contact Name* First Last Business Name* Business Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Phone*Contact Email Address* Preferred Quote Deadline* MM slash DD slash YYYY ELECTRICAL SPECIFICATIONSNumber of Inputs (1-5)*Please enter a number from 1 to 5.Input 1 - Voltage Range* Input 1 - Voltage TypeACDCInput 1 - Current (A) Input 1 - Input ProtectionNoneFusedCurrent LimitedResettable FuseInput 1 - Reverse Input ProtectionYesNoInput 2 - Voltage Range* Input 2 - Voltage TypeACDCInput 2 - Current (A) Input 2 - Input ProtectionNoneFusedCurrent LimitedResettable FuseInput 2 - Reverse Input ProtectionYesNoInput 3 - Voltage Range* Input 3 - Voltage TypeACDCInput 3 - Current (A) Input 3 - Input ProtectionNoneFusedCurrent LimitedResettable FuseInput 3 - Reverse Input ProtectionYesNoInput 4 - Voltage Range* Input 4 - Voltage TypeACDCInput 4 - Current (A) Input 4 - Input ProtectionNoneFusedCurrent LimitedResettable FuseInput 4 - Reverse Input ProtectionYesNoInput 5 - Voltage Range* Input 5 - Voltage TypeACDCInput 5 - Current (A) Input 5 - Input ProtectionNoneFusedCurrent LimitedResettable FuseInput 5 - Reverse Input ProtectionYesNoNumber of Outputs (1-5)*Please enter a number from 1 to 5.Output 1 - Voltage Range* Output 1 - Voltage Tolerance Output 1 - Adjustable Voltage?YesNoOutput 1 - Remote Sense?YesNoOutput 1 - Current (A)* Output 1 - Current Max Limit Output 1 - Output ProtectionNoneFusedCurrent LimitedResettable FuseOutput 1 - Ripple Output 2 - Voltage Range* Output 2 - Voltage Tolerance Output 2 - Adjustable Voltage?YesNoOutput 2 - Remote Sense?YesNoOutput 2 - Current (A)* Output 2 - Current Max Limit Output 2 - Output ProtectionNoneFusedCurrent LimitedResettable FuseOutput 2 - Ripple Output 3 - Voltage Range* Output 3 - Voltage Tolerance Output 3 - Adjustable Voltage?YesNoOutput 3 - Remote Sense?YesNoOutput 3 - Current (A)* Output 3 - Current Max Limit Output 3 - Output ProtectionNoneFusedCurrent LimitedResettable FuseOutput 3 - Ripple Output 4 - Voltage Range* Output 4 - Voltage Tolerance Output 4 - Adjustable Voltage?YesNoOutput 4 - Remote Sense?YesNoOutput 4 - Current (A)* Output 4 - Current Max Limit Output 4 - Output ProtectionNoneFusedCurrent LimitedResettable FuseOutput 4 - Ripple Output 5 - Voltage Range* Output 5 - Voltage Tolerance Output 5 - Adjustable Voltage?YesNoOutput 5 - Remote Sense?YesNoOutput 5 - Current (A)* Output 5 - Current Max Limit Output 5 - Output ProtectionNoneFusedCurrent LimitedResettable FuseOutput 5 - Ripple Thermal Load PropertiesOperating Temperture Range Indicate C or FStorage Temperture Range Indicate C or FThermal Protection? Yes No General SpecificationsDesired Dimensions: Length x Width x Height (inches)Quantity RequiredPreferred Prototype Deadline MM slash DD slash YYYY Preferred Manufacturing Deadline MM slash DD slash YYYY Military Standards to be Met MIL-STD-1399 MIL-STD-461 MIL-STD-704 MIL-STD-810 MIL-STD-1399 Additional details or notesITARS Compliant?YesNoPlatform/End Use Δ