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Company Name
Contact Name
Title
Address 1
Address 2
City
State    Zip  
Phone
Email

 

Product Market
This product will be used in the   market to

 

Model Information
Model #
Test Serial #
Dimensions (in inches) & Weight (pounds)
Width: Depth: Height: Weight:
More than one configuration or version?

 

Power Data
How is it powered? (Please check all that apply.)
Battery
   Does the device charge the battery? Yes No
   Does the device operate while charging? Yes No
Bus-powered (i.e. USB Bus)
AC Power, single phase
              Please enter all possible voltages and the maximum amperage.
               Volts   Volts   Volts  
              Enter max amps. 
AC Power, three phase
               Volts   Amps per phase (max)
DC Power
               Volts   Amps per phase (max)

 

Please list I/O lines
I/O Line Type Quantity Always or usually connected? Greater than 3 Meters

 

Other Important Issues
(Please check all that apply.)
Does the device have a laser?
Any external moving parts?
Can you provide more than 1 unit?
Does it have a pressure vessel?
Does it require a connection to a PC to operate?

 

Wireless Device Testing Only
Check any/all that apply.
802.11A 802.11B 802.11G 802.11N
CDMA/GPRS/GSM
WiMAX
Zigbee
Blutetooth
Frequency or Phase Shift Key (FSK or PSK)
900MHz
2.4Ghz
Spread Spectrum
Frequency Hopping
  Other (Please specify.)

 

Oscillators
(Optional, but helpful.)
Description Frequency (Hz)
1
2
3
4
5

 

Testing Requirements
(Please check all that apply.)
NRTL Mark
CB Scheme
Construction Review
DO-160
MIL-STD-810
MIL-STD-461
CE Mark
FCC/IC (Canada)    FCC Part #
  Specific Standards/Other

 

Countries of Interest
United States
Canada
Europe (EU Countries)
Japan
Australia/NZ
Taiwan
Russia
Korea
China
Mexico
India
  Other

 

Project Information
Yes No   Is this for a 'budgetary estimate' or 'imminent testing'?
Yes No   Is this for 'pre-compliance' or 'final compliance testing'?
   


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