Sample Request Form – Temperature Switches

Media
Set Point - Rising
Set Point - Falling
Differential
Circuit Form
- SPST-NO
- SPST-NC
- SPDT
Circuit | AC - Volts
Circuit | DC - Volts
Pressure | System ~ Normal
Pressure | System ~ Maximum
Pressure | Ambient ~ Normal
Pressure | Ambient ~ Maximum
Media Connection
Electrical Connection
System
- New Design
- Redesign
Application: What will the switch control?
Prototypes Required by (Date)
MM slash DD slash YYYY
Estimated Annual Usage
Other Special Requirements
Contact Information
Project Number or Name*
Company / Firm*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Name*
First Last
Title
Phone*
Email*

Contact Information