Company Name

First Name*

Last Name*

Email*

Phone*

Street Address*

City*

State*

Postal Code*

Country*

Customer P/N (if known)

BMI P/N (if known)

Quantity

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