Custom Solutions Request Form

Required Fields*

    
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CONTACT
Contact Name*
Position*
Phone* 
E-mail*
Confirm E-mail*

COMPANY
Company*
Address 
Company Phone 
Company Fax 
Website 

PROJECT/PRODUCT
Project Name*
Product Industry 
Product Description*
Existing Product* YES   /   NO
New Product * YES   /   NO
NDA Required YES   /   NO
Need by date*
3 year historical
unit volume*
3 year projected
unit volume*

SPECIFICATIONS
Describe heated area,
provide dimensions*
Power Supply Voltage*
Total Wattage Output*
Amps 
Temperature Limits 
Heater Form*      Cable          Tape         Sheet         Advise
Heater cost
range per unit  

CONTROL
Control switch needed * YES   /   NO
Control switch
description 
Control switch cost
range per unit  

SAFETY LISTING
Safety listing
required for product 		YES   /   NO
Type of safety
listing required  
Safety listing standard #  
Thermosoft to coordinate
the listing? 		YES   /   NO

OTHER
Any other
information