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 Duration*:	-- please select -- 3 1 Other
Main Incoming Current Rating*:	Amps (working voltage assumed @ 400v)
Ambient Temperature if over 40°:	°
Enclosure IP Rating IP*:	1 2 3 4 5 6 Other 1 2 3 4 5 6 7 Other

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