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TRANSFORMER SPECIFICATION FORM
        
Date
Company
Address
City
State
Zip Code
Contact
E-mail
Phone #
Fax #
Application
Type of Device
Other(Describe)
Annual Usage
Target Price
Primary Power Source
Frequency
Agency Approvals
UL CSA VDE Other
Other(Describe)
Dimensions to Meet
Hgt Width Length
Shielding?
Electrostatic Magnetic None Other
Other(Describe)
Delivery Date
                                              
PH: 618-985-4838
FX: 618-985-4106
                             
OR YOU CAN JUST CALL OR FAX