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Retractile Cord Worksheet
1) .Type of Retractile Cord:
  (Electronic)

(select one)
2) .Conductor Insulation Material to be Used:
 

Polypropylene
PVC

(select one)
3) .Jacket Material to be Used:
 


Polyurethane
(select one)
4)
.AWG Size and Number of Conductors
5) .Type of Stranded Conductor:
 

Bare Copper

Tinned Copper
Tinsel

(select one)
 
6) .Shielding Requirements:
 



7)
7A
.Retracted to Extended
Length:
to
7B Cord Dia./ Coil O.D.
 
7C Length of Straight
Tangent Ends:
7D Remove Outer Jacket
(R.O.J.) Dimensions

 

 

 

 

7E Conductor Strip
Dimensions:


7F If Conductor is
Twisted and/or Tinned, Specify.
7G
Terminals?
7H Strain Relief Requirement?

.8) EAU/Quantity to Quote? 9) Target Price?
10) Will our AutoCad Print be Required for Approval?

No
11) Will a First-Article Sample be Required for
.......Approval?
Yes
No
12) Can You Submit a Sample Cord, if Necessary? Yes No
13) Upon Approval of Quote/Sample, How Long Until "Buy" is Made?
14) Would you like us to contact you to discuss? Yes No
15) Comments

Contact Information:
*Name, First
*Last
*Company
*Title
*Address 1
Address 2
*City
*State/Prov.
*Zip/Postal Code
*Country
*Telephone
Fax
*email
(Fields with * are required)
 


Post Office Box 910, Pickerington OH 43147-0910
Phone: 614-920-0852, Fax: 614-920-0857, email: sales@hightechcords.com
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