LTM Sales

This form provides our battery charger specialists with the necessary information to quote pricing or help you design a custom battery charger. Please complete this form and list any other helpful information in the "other" section, then submit.

Company Name	Contact		Position

Address	City		State	Zip

Phone	Fax		Email

BATTERY TO BE CHARGED Define Cell(s):
Capacity
Chemistry
Manufacturer
Part Number

Configuration:
Other Features
DESCRIPTION OF CHARGER:
Style:
Wall Mount Desktop Cradle Multi Pocket
Power Supply Type (if known):
Linear Switcher Nexergy to recommend
AC Input:
120VAC 60Hz No. America 220-240 VAC 50Hz Euro/UK 90-130VAC 47-63Hz Asia 90-264VAC 47-63Hz Universal Input
If you know the countries where the product will be sold, but not the AC input available in those countries, list the countries:


DC Input:
Regulatory Approvals
UL/cUL CE Mark UV/GS JIS (T-Mark)
other,specify:

If Multi-Pocket, number of pockets:
Charge Pockets Simultaneously? Yes No
Describe any strong preference for any specific charge device, control method, etc.

Output Connector:

Charge Status Indicator (LED or other)

Other Features

MARKETING INFORMATION
Projections	No. America	Europe		UK
Annual Volume:
Target Price:

Other Market:
Annual Volume:
Target Price:

Competitive Issues:
What product definition exists? (Attributes list, Specification, Drawings, etc.)

Who will design it? Customer LTM Sales

Company Info • Product Lines • Contact LTM Sales