| Company: |
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| Person Requesting Quote: |
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| Address: |
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| Address: |
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| City: |
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| State: |
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| Zip: |
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| Phone: |
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| Fax: |
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| E-Mail Address: |
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INPUT POWER:
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| Amperage per Phase: |
100
200
300
Other - (enter value below) |
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Amperage per Phase: (when other is selected above)
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| Phase: |
3ø, 5 Wire (3 Hots, Neutral & Ground)
1ø, 4 Wire (2 Hots, Neutral & Ground) |
| Reverse: |
Ground
Ground and Neutral
None |
| Connectors: |
Panel Mount
Tails |
| Main Breaker Required: |
Yes
No |
| Input Configuration: |
(Cam-type, Stage Pin, Nema Device, Pin & Sleeve)
NOTE: Connector part numbers are welcome for "Other Input Configuration."
Describe:
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| Feed Thru: |
Will the box require a "Feed Thru" Capability?
Yes
No |
OUTLET TYPES:
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Outlet Type(s) required on the box:
Please list each quanity and type on one line only.
(Example: use (2) NEMA 5-20
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BOX:
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Does the box need to be weatherproof?
Yes
No |
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When is the Custom Box required for use?(mm/dd/yy)
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NOTES: |
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Please use this text box for additional notes,configuration, or special requirements.
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