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BATTERY DESIGN/SELECTION WORKSHEET Fill out this form and submit it to us.  We will contact you shortly to confirm your needs.   Company Information:   Company Name: Phone #:   Contact: Fax #:   Street Address: eMail:   City/State/Zip: Website URL:       Company Type: OEM   Contract Manufacturer   Distributor/Reseller             Timeframe: Date Qty Target Price   Prototypes   Pre-Production   Production       Battery Chemistry: Lead Acid Ni-MH Ni-Cd Alkaline Lithium Li-Ion Other If other, please specify   Specific Manufacturer: Part #:     Voltage: Nominal  Maximum  Minimum     Capacity Requirement:    Ah  or  Wh     Discharge Characteristics: Amps Watts Duration (minutes)   Typical   Maximum   Minimum     Physical Requirements:  (L max.) in.   x   (W max.) in   x   (H max.) in.     Battery Casing:    Soft Pack PVC Shrink   Rigid Plastic Housing   Design Needed     Operating Temperature: Typical  Maximum Minimum   Charging °C °C °C   Discharging °C °C °C   Storage °C °C °C    Discharge Requirements:      Minimum Time:   Maximum Time:    Charger:    Design Needed   Charger Not Needed   Additional Requirements:   10910 Talbert Ave., Fountain Valley, Ca. 92708888 1-888-DIALHOB or 1-800-432-3385 714-962-7600 - FAX: 714-962-7644 e-mail: sales@houseofbatteries.com

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