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