Modified Custom Product Quote Request

Thank you for your interest in the products of MicroPower Direct . With our wide selection of power products we are often able to provide "off the shelf" solutions to fill application requirements. However, even the broadest line of standard products cannot solve every application need. So, we welcome your modified standard or custom product request. Just fill out the form below (as much as possible) and an MPD sales associate will contact you as soon as possible.

	Contact Information
*	Name
	Title
*	Company
*	Phone
	Fax
*	E-Mail
	Product Interest
	Input Specifications
	Input Voltage	Nom.	Range
				to
	Input Filtering Req	Yes	No
	Short Circuit Protection	Continuous		Momentary
	Output Specifications
	Output Voltage (VDC)	Output 1	Output 2		Output 3
	Output Current
	Load Regulation	%
	Line Regulation	%
	Noise & Ripple		mV Pk-Pk
	General Specifications
	Efficiency	%
	Isolated (I/O)	Yes	No
	Isolation Voltage		kVDC
	Physical Specifications
	Case Size (IN)	L	W		H
	Environmental Specifications
	Oper. Temp Range	Low	Nom		High
		°C	°C		°C
	Temp Specified At:	Ambient			Case
	Cooling:	Free Air			Forced Air
	Project Data
	Target Pricing	$	at  Units
	App. Date Proto's Req		mm/dd/yy
	App. Production Start		mm/dd/yy
	Est. Usage Year 1		Units/Year
	Est. Usage Year 3		Units/Year
	Additional Comments