Custom Battery Request Form
 
  Contact Information * Required
  Company *:   Telephone *:    
  Contact Name *:   email *:    
  Street Address:   City, State, Zip:    
  Battery Requirements
  Battery Type *: Rechargeable:
Non-Rechargeable:		 Li-ion LiFePO4 Ni-MH Ni-Cd
Li/SOCl2 Li/MnO2 Other,  specify
 
      Typical Minimum Maximum  
  Voltage (V):    
  Capacity ( Ah mAh):    
  Operating Temperatue ( ºF ºC):    
  Time Frame
      Date Quantity Target Price  
  Prototype:    
  Production:    
  Applications
      Is this a new product? Yes No
  Descriptions of *
any specific requirement 		   
  Verification Code *