Please allow us the opportunity to quote on your next compliance project! Complete all applicable information and submit. A red checkmark denotes a required field.

Your Info

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Job Title		Company
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Address2		State/Province
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Product Information

Product Name / Model
If there is more than one model to test and they are to be tested separately, please generate a separate request for quote sheet for each model.
Description /Application
Standard Required
# of Configurations to Test
What Service?
What Platform?	Choose One Other Space Ground Mobile Ground Fixed Aircraft (External) Aircraft (Internal) Shipboard (Metallic) Shipboard (Above Deck) Shipboard (Non-metallic) Submarines
Does the Device Require ITAR Agreement?			Choose One Yes No
If ITAR required, is the Device on the Munition List?			Choose One Yes No
If ITAR required, what is the category?			Choose One Firearms, Close Assault Guns & Armament Ammunition, Ordnance Launch Vehicles, Guided Rockets, Torpedos, Bombs Explosives & Energetic Propellants, Incendiary Vessels for War Tanks & Military Vehicles Aircraft & Associated Military Training Equipment Protective Personnel Equipment Military Electronics Fire Control, Range Finder Optical & Guidance Auxiliary Military Equipment Toxicological Agents Chemical & Biological Agents Spacecraft Systems Nuclear Weapons Design Classified Articles Technical Data Defense Services Directed Energy Weapons
If ITAR required, what is the classification?			Choose One Unclassified Confidential Secret Special Clearances Top Secret
If ITAR required, is the product for "in the US only" use?			Choose One Yes No
Do you have Documentation on Tests and Levels to be performed. If Yes, please attach or send.			Choose One Yes No
Approx. Device Set-up Time		Choose One Less Than 30 Minutes 1 Hour 2 Hours 3 Hours 4 Hours 4+ Hours
Support and Host Equipment		Choose One Host Equipment in Test Host Equipment Support Outside
Power Requirements		Choose One AC DC AC/DC
Number of Power Connections
Weight of Device:		Height of Device:
Length of Device:		Width of Device:
Does the Device have an Antenna Terminal?  If so, how many?		Choose One Yes No
Power Frequency		Choose One 50/60 Hz Switching 50 Hz 60 Hz 400 Hz Other DC
Power Phase		Choose One Single Phase Three Phase DC Other
Voltage/Amperage
2nd Power Frequency		Choose One 50/60 Hz Switching 50 Hz 60 Hz 400 Hz Other DC
2nd Power Phase		Choose One Single Phase Three Phase DC Other
2nd Voltage/Amperage
3rd Power Frequency		Choose One 50/60 Hz Switching 50 Hz 60 Hz 400 Hz Other DC
3rd Power Phase		Choose One Single Phase Three Phase DC Other
3rd Voltage/Amperage
If more power inputs, please list in Additional Comments section below.
Please list all Cable-Bundles – Include if power is mixed with signal lines:
Type			Length (ft.)	Shielded?
				Choose One Yes No
				Choose One Yes No
				Choose One Yes No
				Choose One Yes No
				Choose One Yes No
				Choose One Yes No
				Choose One Yes No
				Choose One Yes No
				Choose One Yes No
				Choose One Yes No

Additional Comments