Qualtek EMI Filters - Inquiry Form

EMI FILTER
INQUIRY FORM

If you are seeking EMI Filters, complete this form and send it to our offices for a rapid price quotation. If you have specialized needs that cannot be described in the format shown, print this form and mail it to the address below with the necessary drawings and descriptions attached.

Contact Information

Name
Company
E-mail
Phone
Fax

A. Operating Specifications:

1.	Voltage Rating: VAC

2.	Current Rating: A RMS

3.	Operating Frequency: Hz

4.	Leakage Current: VAC Hz mA MAX

5.	Hi Pot Rating (for one minute):
	a. Line to Ground: VAC b. Line to Line: VAC

B. Required Safety Agencies:

UL	CSA	VDE	TUV
SEV	DEMKO	FIMKO	SEMKO
Other

C. Minimum Insertion Loss dB (50 Ohm Circuit):

MODE	Frequency-MHz
MODE	.01	.05	.10	.15	.50	1.0	5.0	10	30
Common
Differential

D. Mechanical Specifications
All dimensions are specified in: mm in

Length
Width
Height

Termination Type:
Input: If "Other" then specify:
Input: If "Other" then specify:

E. Component Value:

L:
Lg:
C1:
C2:
Other:

F. Projected Annual Usage:

First Year
Second Year

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Updated: September, 2007