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Company *
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Date
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Street *
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Job Ref No:
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Suite / Dept / M_Stop
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Job Title:
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City *
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Tel No *
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State + Zip *
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Fax No *
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Country *
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Email *
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Your Full Name *
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Website *
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Annual Usage *
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Target Price
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Estm. Buy Date *
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Current Source
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Current Mfg
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Current Part No
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New Application
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Yes No |
Application Life *
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Engineer’s Name *
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Buyer’s Name *
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Buyer’s Tel No *
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Engineer’s Tel No*
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Is a drawing / data-sheet / sample / prototype available ? Which |
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How did you find our company / website :
Are you an existing Customer? Yes No |
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Connector Specs for the Cable Assembly
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Description
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Left Hand Side
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Right Hand Side
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Hook Up Diagram
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Connector P/N
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Std. Hookup is 1 to 1. Enter RHS pin # to Connect to LHS
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Connector Mfg
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LHS
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1
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2
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3
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4
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5
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6
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7
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Connector Type
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RHS
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# of Contacts
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LHS
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8
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9
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10
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11
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12
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13
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14
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Sex of Contacts
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RHS
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Type of Backshell
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LHS
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15
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16
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17
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18
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19
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20
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21
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Type of Hardware
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RHS
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