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 PRODUCTS & TECHNOLOGY 
 PRODUCT QUESTIONNAIRE 

To receive a quotation on a power supply to meet your exact requirements, please take a moment to complete the following questionnaire. For immediate attention, please send an email or a fax.
Fax 201-475-8710
Email Sales: info@ustechnologies.com
If you have questions on how to answer any portion of the questionnaire, call us toll free at 1-800-234-0862.

Company
Contact Name/Title
Address
City, State & Country
Telephone Fax: **Email:

Power Supply AC to DC with PFC AC to DC w/o PFC DC to DC

INPUT

AC Input Voltage (VAC) 90 to 254 180 to 254 324 to 528 Other (Specify)
  AC Input Voltage (VAC) if Other Specify here:
AC Input Phase Single Phase Three Phase Internal Fuse Circuit Breaker
AC Input Frequency 47 to 63 Hz Other (Specify)    
  AC Input Frequency if Other Specify here:
DC Input Voltage (VDC) 36 to 74 Other (Specify)    
  DC Input Voltage (VDC) if Other Specify here:
Input Connector Hot Plug AC Barrier Strip Other (Specify)  
  Input Connector if Other Specify here:

OUTPUT

Output Power in Watts
Type of Output Single
Channel		 Multiple
Channels		 Isolated
Front End		 Non-Isolated
Bulk

Output Voltages & Currents

Output Connector

1. V @ A 3. V @ A 5. V @ A 7. V @ A
2. V @ A 4. V @ A 6. V @ A 8. V @ A
Hot Plug Flat Bus Bars DC Barrier Strip
Other (Specify) If Other, specify here:

Mechanical Size Case W" x H" x L" Total Space W" x H" x L"
Redundancy (N+1) where N =
Rack / Power Shelf 19" (3U) 23" (3U) 30" (3U) Other (Specify)
Rack / Power Shelf if other, specify here:
Safety Agencies UL CSA TUV CE Marking (LVD)
Other (Specify) if other, specify here:
EMI Cond & Rad EN55022 Level A EN55022 Level B Other (Specify)
EMI Cond & Rad if other, specify here:
Operating Temperature 0°C to 50°C Other (Specify)
Operating Temperature If other, specify here:
Custom Requirement Specify here: Battery Charger
 
Options AC Power Fail DC Power Good
  Current Sharing Remote Enable/Disable
  Isolation Diodes Others (Specify)
  Specify other options here:
Application

QUANTITY & DELIVERY

Prototypes 1 - 5 5 - 10 10 - 20 20 - 100
Production 1 - 50 50 - 100 100 - 250 250 - 500
500 - 1000 Other (Specify)
Delivery Schedule (ARO)
(Specify in # of Weeks)
 Prototypes: Production:

** Required Field

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