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Contact Information

Your Name:*

Title:

Company Name (Full Legal Entity Name):*

Address:*

City:*

County:*

Postcode:*

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Fax:

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Ship to (if different)

Company contact:

Ship to Company:

Shipping Address:

Shipping City:

Shipping County:

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Application Information

Project Name or End Application:*

Circuit Voltage:

Number of Poles:

Ambient Temperature Range:

Continuous Hold Current:

Max Short Circuit Current:

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Part Number Request

E-T-A Part Number:*

Quantity:*

Amp Rating:*

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