Attention:

Human Resources Sales Customer Service Marketing Production Quality Assurance

Your Name*:

Title:

Company Name*:

Address*:

City*:

State*:

    Zip/Postal Code:

Country*:

Phone Number*:

()

Fax Number:

()

Email Address*:

Shipping Address (If different than above)

Description of Application/Product Use*:

Contact Form*:

 Normally Open (Form A)
(when magnetic filed is not present the switch is open)
 Normally Closed (Form B)
 Normally Open and Closed (Form C)

Overall Dimensions the Switch Needs to Fit Into:

 Case Style (Model Series )
 Internal Qualifying Form

Maximum Electrical Load the Switch Will Be Exposed To*:

Voltage:   AC  DC
Current:  amps
Power:   watts

Make and Break Distance Between Magnet and Switch:

Make:
Break:

Actuating Magnet*:
View Magnets

RSD catalog # or
 Customer Supplied

Environment*:

 Wet   Dry
Shock: g’s       Vibration: g’s
Temperature:
Exceed -40C to 105^oC? No Yes ^oC

Do You Have a Drawing?*

 Yes   No
Drawing required for custom sensors

Expected Life Cycle:

Leads*:
View Wire

 Wire   Cable
Type of Material: PVC  Teflon  Other
Gauge of Wire or Cable:
Length of Leads:

Type of Connector Required:

Estimated Annual Volume*:

Target Price*:

Estimated Production Date*:

Standard Packaged:
Packaged Product Catalog

 Yes  Catalog # - -

Custom Packaged:

 Yes  Catalog # - -

Any Other Questions or Comments:

None