First Name*

Last Name*

Company*

Telephone*

Your Email*

Annual Quantity*

Application* (intended use)

General Description*

Load voltage, nominal* (required during operation)

Nominal load current* (typical discharge current during operation)

Application temperature range*

Capacity*

Cell Chemistry*

Define proposed charging scheme and other requirements*

Attach drawing or provide preliminary sketch of battery pack needs. File types accepted: gif, png, jpg, pdf, doc.* (Important: Include information on labeling and packaging)