Applitek Technologies Corporation

	Tomorrow's Crimp Technology Today!

APPLITEK™ EZ-QUOTE:

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1. Contact Information:

Company Name:
Contact Person (for this quote)
E-mail Address:
Street Address:
City/State/Zip:	,
Country:
Phone:
Fax:

2. Terminal Information:

Terminal Manufacturer:
Manufacturer's Part #:
Your Terminal Part # (if applicable):

Terminal to be inserted in housing?: Yes No
Is there a seal or grommet applied?: Yes No
Crimp Barrel Type: Open Closed


Please indicate carrier strip configuration: (1) End-to-End (2) Front (3) Rear (4) Front and Rear (5) Center (6) Front and Center (7) Rear and Center (8) Front, Rear and Center

Select Feed Orientation: Rear (End-to-End) Left-to-Right Right-to-Left

3. Press Information:

Crimping Press Manufacturer:
Model:
Will applicator be used as Bench?
Or, with Fully Automatic equipment?
If Automatic, please specify Manufacturer and Model No. of equipment:
Manufacturer:
Model No.:

4. Wire Information:

Wire Gauge(s):
Number of strands in conductor:
Insulation Diameter(s):
Pull test (minimum):
Indicate number of wires to be crimped simultaneously: Single Double

5. Crimp Specification Information:

If crimp specifications are required, please indicate below
dimensions and tolerances allowed:

Conductor Crimp:

height .

. width

Insulation Crimp:

height .

. width

NOTE: Unless otherwise specified above, APPLITEK will develop appropriate crimp specs based on terminal and wire supplied. If a housing is required, a sample must be supplied.

6. Additional Notes:

A) For quoting, a one foot strip of terminals and wire(s) are required.
If available, actual crimped samples and/or a terminal dwg would be helpful.

B) When ordering, a six foot strip of terminals and wire(s) will be required.
If applicable, housings and seals/grommets must also be supplied.

7. Additional Comments:

Filling out this field will result in your form being rejected.