CUSTOM DESIGN
     MANUFACTURING
     & TEST

CONTRACT
     MANUFACTURING
     & TEST

REPAIR & TEST

SELECT PRODUCTS

QUALITY
     CONTROL

CAPABILITIES

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CONTACT US

REQUIREMENT
     FORM

RETURN TO
     HOMEPAGE
Requirement Reply Form

TO: ASTRO-GEO-MARINE, INC.
2186 KNOLL DRIVE, #B
VENTURA, CA 93003
PHONE: 805-654-8300
800-2000-AGM (800-200-0246)
FAX: 805-654-8314
Name:
Company:
Address:
Address:
City, State
Zip Code
Phone:
Fax
E-mail:

SPECIFICATIONS:
INPUT RANGE
A/C OR D/C
1-PHASE OR 3-PHASE
OUTPUT RANGE (Volts/Amps)
1.
2.
3.
4.
5.

TEMPERATURE RANGE:

Operating

Storage

EFFICIENCY

FREQUENCY

REGULATION / RIPPLE
1.
2.
3.
4.
5.

PHYSICAL REQUIREMENTS
Size, Weight, Mounting, Termination, etc.

REMOTE (ERROR) SENSING Y N ; REMOTE (VOLTAGE) PROGRAMMING Y N

COMPUTER PROGRAMMABLE Y N IF YES, IEEE488 RS232

OTHER SPECIFICATIONS & PROVISIONS:

QUANTITY: DELIVERY:

Submit form or Fax Completed form to: (805) 654-8314

2186 KNOLL DRIVE, #B • VENTURA, CA 93003
TOLL FREE: 800-2000-AGM (800-200-0246) • TEL: (805) 654-8300
E-MAIL: SALES@ASTROGEOMARINE.COM • FAX: (805) 654-8314

| CUSTOM DESIGN MANUFACTURING & TEST | CONTRACT MANUFACTURING & TEST |
| REPAIR & TEST | SELECT PRODUCTS | QUALITY CONTROL | CAPABILITIES |
| ABOUT US | CONTACT US | REQUIREMENT FORM | RETURN TO HOMEPAGE |