Please download this sample request form and fill it to send us by fax
.

To: UCHIYA THERMOSTAT CO., LTD.                        Date(month/day/yr):                        

Fax : 81-489-56-1310 ( Marketing Div.)          Ref. No. (for your use):                   

  

Sample Request Form
(Device for appliance)
  

Company:                         Div/Dept:                     Requested by:                      

Tel No.:                     Fax No.:                          E-mail:                            

Address:                                                                                          
  

Application（Final Product）:                                                                     

  □Motor: Motor Type                          Full Load Current     A, Locked Rotor Current    A

  □Transformer: Located in    □ Primary      □ Secondary

  □Other:                                                                                      
  

Thermostat function: □Temperature control   □Overheat protection   □Overcurrent protection

Electrical ratings:            V□AC □DC             A□Resistive □Inductive

Varnish: □Non   □Dipping   □Vacuum impregnation, condition                                    

Ambient conditions for use: Min.- Max.Temp.        -        degC     Normal temp.         degC

         □Gas              □Dust             □Humidity         %  □Other                  

Contact system:   □ Open circuit on temperature rise (normally closed)
                  □ Close circuit on temperature rise (normally open)

Temp spec. (at no load): operating          +/-       degC   resetting          +/-       degC

Lead wire spec.: insulated          mm   strip         mm   □With solder   □Without solder

Required safety standard:  □UL    □CSA    □EN     □Other                                   

UCHIYA model No:           Sample quantity required:      pcs    Sample required date:            

Reference information (such as competitive product):                                             

Production: schedule                       production quantity          pcs/month

Quotation: □need  □no need

Other request: