Data Aquisition System Application Information *indicates required information
Company Name:Contact Name:*
Address 1:Phone #:
Address 2:Fax #:
Email:*
General
Application
Statement:
Product Information
Data to be Stored: :

Sample Rate

Maximum Storage Period
Number of inputs: Discreet Analogue Signal Format: Digital Protocol of DIgital:    
Number of outputs: Discreet Analogue Signal Format: Digital Protocol of DIgital:  

Communication Required:

Operator Interface: On-Board Computer Interface:

Power Available:
VDC: Two Wire: VAC: Hz:
Characteristics

Housings:
Controller:
Std:     Nema 4:     Nema 4x:  

CL1 DIV 1:     CL1 DIV 2:     CL 2 Div 1:    Cl 2 Div 2:    

Instrinsically Safe:    

Electronics:
Std:   Nema 4:     Nema 4x:    

CL1 DIV 1:     CL1 DIV 2:     CL 2 Div 1:    Cl 2 Div 2:    


Ambient Temperature:     Celcius   Fahrenheight
Special Quoting Conditions:
 		Miscellaneous Details: