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Application Worksheet
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Application Description
Please describe your battery or cable application:
Battery Requirements
Battery Type:
Primary
Secondary
Not Sure
Voltage:
Min
Typ
Max
Capacity:
Min
Typ
Max
Please specify the unit of measurement for capacity:
ampere-hours (Ah)
milliampere-hours (mAh)
What batteries are you currently using or considering?
(Chemistry, voltage, capacity, cell/battery type, manufacturer, etc.):
Quantity Requirement & Timing
Quantity
Date Needed
Prototype Requirement (if applicable):
5-10
11-50
51-100
More than 100
To be determined
Estimated Annual Quantity:
Less than 500
501-2,500
2,501-10,000
10,001-50,000
50,001-100,000
More than 100,000
Cable Requirements
Connector A
Connector B
Gender
Gender
Choose One
Male
Female
Blank
Choose One
Male
Female
Blank
Connector Type
Connector Type
Choose One
DB9
DB15
DB25
DB37
DB50
IDC
Circular
Header
Unterminated
Spade Lugs
Other
Blank
Choose One
DB9
DB15
DB25
DB37
DB50
IDC
Circular
Header
Unterminated
Spade Lugs
Other
Blank
Special Features
Special Features
Choose One
EMF/RFI
Pin Only
Screwlocks M/F
90 Degree Potted
Molded
Environmental/Not Molded
Blank
Choose One
EMF/RFI
Pin Only
Screwlocks M/F
90 Degree Potted
Molded
Environmental/Not Molded
Blank
Wire Type
Wire Type
Choose One
Teflon
Tefzel
PVC
Other
Blank
Choose One
Teflon
Tefzel
PVC
Other
Blank
Jacket Type
Jacket Type
Choose One
Rubber
Polyurethane
PVC
Braided
Tie Wrap
Expando
Other
Blank
Choose One
Rubber
Polyurethane
PVC
Braided
Tie Wrap
Expando
Other
Blank
Cable Types
Cable Types
Choose One
Unshielded
Foil Shielded
Foil and Copper Braid Shielded
Conduit
Ribbon
Other
Blank
Choose One
Unshielded
Foil Shielded
Foil and Copper Braid Shielded
Conduit
Ribbon
Other
Blank
Additional Comments
Contact Information
Your Name *
Company
Market
Oilfield Services
Military
Geophysical/Seismic
Marine
Space
Medical
Pipeline Inspection
Remote Monitoring
GPS/Security/Law Enforcement
Telecommunications
Other
Address
Address 2
Address 3
City
State/Province
Zip/Postal Code
Country
Email *
Phone *
* Required Fields
Your e-mail address and personal information are confidential. We do not sell or give this information out. This information is secure.
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SouthWest Electronic Energy Corp
