Medical Products 
Request / Order Form

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Name:
Company Name:
Street Address:
City:
State:
Zip Code:
Phone Number:
Fax Number:
E-Mail Address:

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Inductor Type:
Inductance Required:
Average DC Current:
Ripple Current:
Max. Size Wound Unit:
Max. Size Copper Resistance:
Max. Line Voltage:
Frequency:
Core Geometry:
Breakdown Voltage Required:
Tolerance:
Toroid Max. OD:
Toroid Min. OD:
Ripple Frequency:
Bias Current:
Pk. to Pk. or RMS?:
Peak Current:
Line Current & Frequency:
Min. Q:
Trim Range (Pot Cores):
Quantity:
Additional Information Desired: