Company Name

Name*

Email*

Phone*

Fax

Street Address & City*

State or Country*

Customer P/N (if known)

BMI P/N (if known)

Quantity

Quote Type*

Capacitance Rating uF*

Voltage Rating (VDC or VAC)*

Terminal Type (Dual Blade Standard - if applicable)

Capacitance Tolerance (in % - if applicable)

Max Allowable Case Dim (in inches or mm - if applicable)

ESR Limit (in Ohms at ___ Frequency - if applicable)

Ripple Current Limit (in Amps at ___ Frequency - if applicable)

Capacitor Temp. Rating (if applicable)

Power Factor Limit (in % at 60Hz - if applicable)

Other Requirements

* Required