Quotation for EMC - Step 1

Company
Name: 		Contact:
Address 1: Address 2:
City: State/
Province:
Country: Postal
Code:
Phone: Email:
Product
Model: 		Product
Brand:
Year of
Introduction:		 Type of
Device:
Is this product an accessory to a wireless device?  Yes   No
Give a brief description of the functions that your device performs.
How many unique configurations are to be tested? 
How many modes of operation on each configuration are to be tested?
Power Requirements:  AC   AC/DC Power Supply   DC   Battery
Power Phase:  Single Phase   Three Phase
If Voltage or EUT?  110V   230V   Other 
Current of your product?  Amps
Power Frequency of your product?  50Hz    60Hz    Other 
Number of power cords? 
Frequency of clock oscillators in your system? 
Frequency of highest clock oscillator in your system? 
How many interface cables are intended to be over a 3 meter length? 
Indicate any interface ports on your product:
  RJ11   T1/E1   DSL   ISDN   RS232   Other 


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