Contact InformationAccount #Name* First Last CompanyPhone** Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Email* ChemistryDoes your battery need to be rechargeable? This will help in determining the chemistry to use.RechargeableNon-rechargeableRechargableNickel Cadmium (NiCad), 1.2 volts per cellNickel Metal Hydride (Ni-Mh), 1.2 volts per cellNon-rechargeableCarbon Zinc or Alkaline, 1.5 volts per cellLithium Coin (Li), 3 volts per cellLithium Thionyl Chloride (Li/SOCL2), 3.6 volts per cellElectrical RequirementsVoltage: What is the voltage of your pack? To calculate the voltage, simply multiply the voltage per cell for the finished voltage. Adding cells in a series increases voltage. Example: 3 cells x 2 volt ea. = 6 volt pack Operating Voltage:MaximumNominalMinimum (cut-off)Amperage/ Capacity: What is the amperage of your battery? This helps determine the cell size. Cell sizes are not mixed when assembling a battery pack. Adding cells in parallel increases amperage.Constant CurrentPulse Current (lp)DurationConstant CurrentuAmAmAAuAMillisecondsSecondsMinutesHoursEveryExpected Operating LifeStorage of battery before use:MillisecondsSecondsMinutesHoursDaysWeeksMonthsYearsYearsMonthsYearsMonthsConfigurationWhere does this battery need to fit? By aligning the cells in various ways, the voltage and amperage can remain the same, yet the packs can be made to fit almost anywhere. Linear or F Type Multi-Row Cells Nested Type Cells Face centered Cubic Circular Type Cells (3-cell pack/ 4-cell pack) Linear or L-Type Cells TerminationHow is the battery pack going to give its power and accept a charge if needed? We can add nickel tabs for soldering to, or wires for connections, or reuse your previous connector if you're replacing an existing pack. Nickel Tabs Wires Connector Nickel Tabs - LengthNickel Tabs - WidthMillimetersInchesUntitledMillimetersInchesWires LengthWires - AWGWires - MaterialMillimetersInchesMillimetersInchesConnector - Manufacturer?Connector - P/N?Connector - Pin Orientation?Connector - Crimp P/N?Cell SizePlease specify cell sizeAAA5/4 AAA5/3 AAA1/3 AA1/2 AAAA2/3 AA4/5 AA2/3 sub-Csub-C1/2 CC1/2 DDFMax Length Available (mm)Max Width Available (mm)Max Height Available (mm)Assembled Pack DimensionsMax Space Available (mm):LengthWidthHeightEstimated Annual Requirement1st Year2nd Year3rd YearQualification Testing and/or CertificationDo you have Qualification or Certification test results for this pack?YesNoUploadDo you want a quote?YesNoCAPTCHA
