Request For Quote— EMC and Product Safety
Please submit the completed form below and we will contact you shortly.
Company Information Company Name:
Address:
Contact Person: Title:
Phone Number: Fax Number:
Email:
Website:
Manufacturer Information
Same as above
Manufacturer Name:
Equipment Under Test (EUT) Description
Model Designation:
EUT Description:
Intended Use:
Intended Locations:
Available Options:
Configurations to be Tested:
Electrical Rating: Vac/dc: Hz: Amps: Dimensions: Weight:
Table Top Floor Standing Rack-Mounted
Objective of Testing
EMC United States (FCC) Canada (ICES) European Union (CE Mark) Taiwan (BSMI) Japan (VCCI) Other:
Safety Standards (if Known) UL (US) UL (Canada) CSA (US) CSA (Canada) TUV Rheinland (US) TUV Rheinland (Canada) TUV Rheinland GS Mark TUV Rheinland CB Report TUV America (US) TUV America (Canada) TUV America GS Mark LVD Report (CE Mark) Machine Directive Report (CE Mark) Other
Support Equipment to be Used During Testing Equipment: Manufacturer: Model/ Part #: Equipment: Manufacturer: Model/ Part #: Equipment: Manufacturer: Model/ Part #: Equipment: Manufacturer: Model/ Part #: Equipment: Manufacturer: Model/ Part #: Equipment: Manufacturer: Model/ Part #:
Interconnecting Cables to be used during Testing
Cable Type: Cable Length: Shielded Yes No Cable Type: Cable Length: Shielded Yes No Cable Type: Cable Length: Shielded Yes No Cable Type: Cable Length: Shielded Yes No Cable Type: Cable Length: Shielded Yes No
Please list all know fundamental frequencies (if requesting EMC testing):
Is the product an intentional radiator? Yes No
Is the product for home use? Yes (Class B) No (Class A)
Additional Information: Please Provide us with any additional information regarding your request in the field below.
Requestor Name (to act as electronic signature): Date: