Custom Product Request

Astrodyne can customize a power supply product to meet your specific need. Please complete the specification for below and submit to us for review. Be as detailed as possible and include any notes regarding your application that may help us specify the exact product match. We will contact you regarding the best product solution to match your requirements in a short time.

Contact Information
First Name:	*	Last Name:	*
Company:	*	Title:
Address Line 1:	*
Address Line 2:
City:	*	State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland Northwest Territory Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory *    Zip: *
Country:
Phone:	*
Fax:
Email:	*

General Information
Prototype Quantity:	Annual Quantity: *	Expected Delivery Date: *
Input Voltage Range
Min:	Max:	Multiple:

Outputs	Output 1	Output 2	Output 3	Output 4
Min Current:
Max Current:
Nominal Volts:
Tolerance/Adj:
Current Limit:
Over Voltage Protection:
Safety Standards
Notes:
Environment Standards
Dimensions:	x x
Input Connector:
Output Connector:
Package Style:
Additional Notes