General Request Form Regarding Specific Parts & Availability

General Request Form Regarding Specific Parts & Availability
Please supply the requested information below so we can contact you in response to your question(s). Presidio Components does not sell or distribute this information to outside sources.
(* indicates a required field)
Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Company Name*
Job Title
Street Address
City*
State
Zip or Postal Code
Country*
Fill in part numbers and quantities below:

(if applicable)
Presidio Part No (#1)
Your Part No.
Dwg #
(if any)
Quantity
Presidio Part No: (#2)
Your Part No.
Dwg #
(if any)
Quantity
Presidio Part No: (#3)
Your Part No.
Dwg #
(if any)
Quantity
Maximum Operating Temperature?
Maximum Operating Voltage?
Mission Duration at Operating Voltage & Operating Temperature?
Minimum Capacitance Value Required at Operating Voltage & Temperature?
Maximum Allowed Dimensions and Other Details

Enter Dimensions Below
Width:
Length:
Height:
Type of Solder or Attachment to Be Used?
Will Parts Be Using DC or AC Voltage?

DCAC
If AC, Please Confirm Operating Frequency:
What Lead Style is Needed for Stacked Capacitors?
Is RoHS Compliance Required?

YesNo
If RoHS is YES, is Exemption 7A Allowed?

YesNo
Is This for a Space Application?

YesNoUndecided
Do you have any other requirements or special needs?
Quantity and Date Needed?
Quantity:
Date Needed:
Should be Empty:

Fill in part numbers and quantities below: