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BATTERY APPLICATION PROFILE:

Please fill out the following information and press the SUBMIT button.

This form is intended for OEM use and will only be considered for custom made batteries. All other requests, including small quantities of custom made batteries, must be placed via telephone. All fields regarding the details of your battery application must be filled out. Incomplete forms will not be considered.

*Required Fields

Your Name*
Your Company*
Address1*
Address2
City*
State*
Zip*
Country
Phone*
Fax
e-mail*
How did you hear of us*

Type of Application:

Battery Type: Rechargeable Non-Rechargeable

Battery Chemistry: NiCd NiMH Lead Acid Alkaline Lithium

Specified Source: (cell mfg. / model)

Voltage: Nominal= V; Minimum= V; Maximum= V

Ambient Temperature (Deg C): Min.= ; Avg.= ; Max.=

Discharge (Amps): Avg.= ; Peak= ; Min.=

Discharge Time (Hours): Total= At Peak

Charging (mA): Standard= ; Trickle= ; Quick (4-6 hrs)=

Rapid Charging (mA) (1 - 1.5hrs):

Overcharge/Short Circuit Protection:

Mfg. Part number

Mechanical Dimensions (mm): (L) x (W) x (H)

Pack Assembly Description/Specification:

Is Drawing available? YES NO

Lead Wire: Length= mm; Gauge= AWG

Connector: Mfg Name= Part No.=

Forecast Production: Qty/mo.= Qty./yr=

Start Date

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