Contact Information
Company Name*:
Contact Name*:
Telephone Number*:
Email*:
Country*:
Company Address:

Project Information
Short Circuit Fault Level*:	-- please select -- 100 80 65 50 25 20 Other
Short Circuit Fault Duration*:	-- please select -- 3 1 Other
Full Load Current*:	Amps
	(working voltage assumed @ 400v)
Ambient Temperature if over 40°:	°
IP Rating*:	1 2 3 4 5 6 Other 1 2 3 4 5 6 7 Other
Environment*:	-- please select -- Rolling Stock Underground Use Shipping Indoor Outdoor
Incoming Device Manufacturer*:
1st Incoming Device Type and Rating*:	-- please select -- Fixed Withdrawable Plug in Amps
Number of Poles/Phases:	-- please select -- 2-DC 3-PHASE 3-PHASE + N 3-PHASE + N + E
2nd Incoming Device Type and Rating:	-- please select -- Fixed Withdrawable Plug in Amps
Bus Coupler Type and Rating:	Amps
Outgoing Device Manufacturer:
1st Outgoing Device Type and Rating:	-- please select -- Fixed Withdrawable Plug in Amps
2nd Outgoing Device Type and Rating:	-- please select -- Fixed Withdrawable Plug in Amps
3rd Outgoing Device Type and Rating:	-- please select -- Fixed Withdrawable Plug in Amps
4th Outgoing Device Type and Rating:	-- please select -- Fixed Withdrawable Plug in Amps

Enquiry Information
Enquiry Reference No:
Price Required by:	dd 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / mm 01 02 03 04 05 06 07 08 09 10 11 12 / yyyy 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Delivery Required:	dd 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 / mm 01 02 03 04 05 06 07 08 09 10 11 12 / yyyy 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Comments/Notes:
Attach DWG:
Attach Specification:

	*required fields
This information will not be passed on to any third parties and will only be used by the Ter-mate Group of Companies