In order to expedite your request for a quotation, please print and fill out this form and fax it back to us at (203) 853-9304 Attn. Sales. We will review your request and make every attempt to return your inquiry within 24 hours.
COMPANY: ________________________________________________
ADDRESS: ________________________________________________
CITY/STATE/ZIP: ___________________________________________
PHONE: _________________________________
FAX: ____________________________________
CONTACT: ________________________________________________
DEPARTMENT: ________________________________________________
PRODUCT TO QUOTE ON: (Please check off all specifications)
___ DOMESTIC ___ INTERNATIONAL
___ CORD SET ___ DETACHABLE CORD SET
___ HOSPITAL GRADE CORD SET ___ BULK WIRE
___INTERNATIONAL CORD SET MALE PLUG ___ FEMALE PLUG ___ BOTH
SPECIFICATIONS:
2&3 CONDUCTOR "SPT" TYPE
___ 24/2 ___ 22/2 ___ 20/2 ___ 18/2 SPT-1 ___ 18/2 SPT-2 ___ 18/3 SPT-1
___ 18/3 SPT-2 ___ 16/2 SPT-2
2&3 CONDUCTOR "ROUND STYLE"
___ 18/2 SJT ___ 18/2 SVT ___ 18/3 SJT ___ 18/3 SVT ___ 16/2 SJT
___ 16/3 SJT ___ 14/2 SJT ___ 14/2 SJT
LENGTH:_________ MALE PLUG:_________ HOSP. PLUG _________
FEMALE PLUG: _________
COLOR:
___ BLACK ___ WHITE ___ BROWN
___ CLEAR GOLD ___ GREY ___ OTHER
SILT_________ " STRIP_________ "
REMOVE OUTER JACKET (ROUND STYLE ONLY)_________ "
ENDS TINNED_________ ENDS TERMINATED _________
(VENDER & PART #) _____________________________________
FOLD & TIED (HANKED): _________
BUNDLES (UNHANKED): _________
QUANTITY: _________
EST. ANNUAL USAGE: _________
BULK WIRE: (Check off specs from above)
AMOUNT PER REEL_________ FT
TOTAL FOOTAGE_________ FT
INTERNATIONAL CORD SETS
COUNTRY_________
LENGTH _________
2 CONDUCTOR _________ 3 CONDUCTOR _________ BOTH _________
MALE _________ FEMALE _________ BOTH _________
REMOVE OUTER JACKET _________ " STRIP INNERS _________ "
ENDS TINED _________ ENDS TERMINATED _________
(VENDOR NAME AND PART #)
COLOR:
____ BLACK ____ WHITE ____ LIGHT GREY ____ DARK GREY
FOLD & TIED (Hanked) _____________________
QUANTITY ______________________
ESTIMATED ANNUAL USAGE ___________________