Magcap Engineering - Request for Quotation

Customer Information

*	First Name:
*	Last Name:
	Title:
*	Company:
	Address 1:
	Address 2:
	City:
	State:	Zip:
	Country:
*	Telephone:
	Fax:
	E-mail:

Custom Design Specifications
Application:
Existing Customer or MagCap Part Numbers, if any:
Customer Part No.
MagCap Part No.
QTY Required:
Primary Voltage:		Primary Test Voltage:
Phase:		Line Frequency:
No. Of Secondaries:
Secondary Voltage(s):
Secondary Current(s):
Secondary Operating Voltage Above Ground:
Special Electrical Requirements:
Special Mechanical Requirements:
Additional comments:

Form Submission
Mailing Lists:	Please add me to the following list(s) for product updates and announcements. E-Mail Fax

* required field

Complete the boxes below with as much detail as possible. Fields marked with an asterisk ( * ) are required for submission. Once complete, click the [Submit] button to send information to MagCap Customer Services. You will receive a response back from a MagCap Engineer within 24 hours.