CUSTOM CABLE REQUEST FORM

*Fill in form below or click on "Custom Cable Request Form" for Adobe Acrobat version (PDF).

Bolded questions indicate required questions

CONTACT INFORMATION:

Company: Phone Number: Address: City and State: Zip Code: Fax: Email: Contact Person:

DESCRIPTION:

Part Number: Description:

CABLE LENGTH INFORMATION:

Footage: Cont. Lengths: Multiples: X feet

GENERAL QUESTIONS:

Cable Application: Number of conductors, AWG size: Specific Components (i.e. Coax, Impedance, Twisted Pairs, Triads, Fibers): Insulation Preferred: Voltage: Temperature Range: Shielding Overall: Yes No Preferred Shield Type: Individual Shields: Yes No Environment: Breaking Strength: Working Load: Mechanical Armor:

UNDERWATER QUESTIONS:

Underwater: Yes No Depth: Duration (hours/days/months/years): Water Blocking: Yes No

FLEX STATUS:

Please check all that apply: Non-Flex Min Flex Moderate Flex Cont. Flex Mini Bend Radius: Cycles:

JACKET/TERMINATION:

Outer Jacket: Molded Termination: Yes No Preferred Diameter: