| Name: * |
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| Company: * |
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| Address 1: |
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| Address 2: |
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| City: |
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| State/Province: |
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| Zip: |
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| Country: |
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| Phone: * |
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| Fax: |
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| Email: * |
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| Cord Sets |
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| Types: |
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| Right Angle Ground Pin: |
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| 2 Conductor Blade Type: |
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| Length: |
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| Removal of Outer Jacket (ROJ): |
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| Color: |
Other:
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| Wire Type: |
Other:
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| AWG Type: |
Other:
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| NEMA Type: |
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Termination
Appliance End: |
Other:
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| Extension Cords |
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| Plug Type: |
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| AWG: |
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| Length: |
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| Color: |
Other:
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| International Cord Sets |
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| Types: |
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| AMP Fuse (UK only): |
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| Colors: |
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| Length: |
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| Removal of Outer Jacket (ROJ): |
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| Application/Comments: |
Please provide a brief description of your application
and any other comments:
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