Company Name:______________________________________________________________________
Address:___________________________________________________________________________
Telephone Number:____________________________ FAX Number:__________________________
Person to Contact:_________________________________________________________________
Lead Time to Prototype:____________________________________________________________
Production Quantities Anticipated:_________________________________________________
The following questionnaires are for your convenience only.  If you would prefer to
discuss your requirements with a design engineer,feel free to phone (909) 626-2722.

1. Input voltage nominal________________ + _________________ - ___________________
2. Input frequency nominal______________ + _________________ - ___________________
3. Any special characteristics regarding input wave forms, i.e., square wave or
   excessive distortion?__________________________________________________________
   If so, describe:
   _______________________________________________________________________________
   _______________________________________________________________________________
   _______________________________________________________________________________
   _______________________________________________________________________________
4. Output number 1:
   Output voltage___________________ + ___________________ - _____________________
   Load current________________________  Duty Cycle_______________________________%
   Type of Load, resistive____________________ Inductive__________________________
   Will this output be rectified and filtered prior to loading____________________?
   If yes,  describe that network below:
   _______________________________________________________________________________
   _______________________________________________________________________________
   _______________________________________________________________________________
   _______________________________________________________________________________
5. Tolerable variation of output as a result of load and input line changes:
   (regulation)___________________________________________________________________
6. Is the load sensitive to pulses or noise such as caused by switching circuitry
   or motors? (logic networks, strain gage circuits,  low level signals to amplifiers
   or ungrounded loads)___________________________________________________________
   If so,  what order of magnitude electrostatic shielding do you anticipate?
   _______________________________________________________________________________
   _______________________________________________________________________________
   _______________________________________________________________________________
7. If the transformer described above will have more than one output winding, click
   to question 4 above.
8. If multiple outputs are required, will all outputs be loaded simultaneously?
   _______________________________________________________________________________
   Describe any unusual loading that may occur:
   _______________________________________________________________________________
9. Describe the environment in which this transformer must operate
   (temperature, humidity, extremes, et. et..)
   _______________________________________________________________________________
   _______________________________________________________________________________
   _______________________________________________________________________________
10. Will this transformer be required to satisfy military specifications?
   _______________________________________________________________________________
   UL or CSA?
   _______________________________________________________________________________
   If yes,  identify the specifications:
   _______________________________________________________________________________
11. Describe the space allocated for this transformer.  Include the size and shape
   _______________________________________________________________________________
12. If available, provide any preconceived physical appearance of this transformer
   to show mounting method,  terminations (leads, solder lugs, glass sealed terminals,
   etc.)._________________________________________________________________________
   _______________________________________________________________________________