Company

Date:

Street:

Job Ref No:

Suite / Dept / M_Stop

Job Title:

City

Tel No:

State + Zip

Fax No:

Country

Email :

Your Full Name:

Website

Annual Usage:

Target Price

Estm. Buy Date

Current Source

Current Brand

Current Part No

New Application

 Yes No

Application Life

Engineer’s Name:

Buyer’s Name

Buyer’s Tel #:

Engineer’s Tel #:

Is a drawing / data-sheet / sample / prototype available ? Which   

How did you find our company / web site : Search Engine Catalog Human Referal Trade show Customer Other Select            Are you an existing Customer?      Yes    No

Select Switch Type

Toggle Rocker Slide Push Button Dip Switch Tact Switch Illuminated Rocker Key Lock Limit Switch Custom Select  

Select Mounting Style Panel Mtg PCB Mtg Flex Circuit Cat.Std

Select Terminal Style

Solder Eye Surface Mtg Dip Solder / PCB Faston Terminal Wire Lug Screw Terminal Cat. Std   

Circuit Style:

Temp Hi Low 

Select Soldering Process

Hand Solder Flow Solder SMT Welding Custom Select         

Contact Orientation: Straight R/Angle Cat.Std Custom

Knob Style / Type:

Round Square Lasered Painted Custom Cat.Std             

Voltage    AC       DC

Amps    Hertz

Application

Airborne Marine Military Industrial Instrumentation Automotive Select       

Panel Thickness

PCB Thickness 

Illuminated Switches Only

Lens Color :

Lamp / Led Color :

Contact Plate: Tin / Nickel Tin Silver Gold Cat.Std

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Disclaimer: Alpha Products, Inc. makes no warranties, expressed or implied, including warranties of merchant ability or fitness /suitability for a particular purpose or application. Under no circumstances shall Alpha Products, Inc. be liable for incidental, consequential, or other damages from alleged negligence, breach of warranty, strict liability, tort, contract, or any other theory, arising out of the use, non use, or handling of these products. Unauthorized duplication / downloading forbidden by US. Laws - Alpha Products Inc.