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| Indicate Military Designation Number, if known. For example: "M21038/27-05" |
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| For specification help, indicate turns ratio. |
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| For specification help, indicate package (surface mount, through-the-board, non-QPL low profile, other) |
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| For specification help, indicate temperature range. |
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| For specification help, indicate single or dual transformer within package. |
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| Other requirements (sampling, testing, please describe). |
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| What are your quantity needs and projected timetable (if any)? |
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| Do you have other transformer or magnetic product needs? Please describe. |
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| Name: * |
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| Company: * |
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| Title: |
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| Department: |
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| Address1: |
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| Address2: |
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| Address3: |
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| City: |
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| State: |
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| Country: |
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| Postal Code: |
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| Phone: * |
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| Extension: |
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| E-mail: * |
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| URL: |
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| Fax: |
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| How did you hear about Hytronics? |
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