Custom Battery Request Form - Ultralife Batteries, Inc.

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Custom Battery Request Form

Please complete our Custom Battery Request Form to help us identify the right solution for your needs.

Once this form is submitted, an Ultralife Applications Engineer will reply to you with a recommendation regarding an Ultralife battery for your application.

Fields followed by an * are required to submit a worksheet.

Briefly describe your battery requirements

Battery Type *
Voltage	min	typ	max
Capacity	min	typ	max
Please specify the unit of measurement for capacity: ampere-hours (Ah) milliampere-hours (mAh)

Briefly decribe your battery application

Is this a new product?
Yes

	QUANTITY	DATE NEEDED
Prototype Requirements (if applicable)
Estimate Annual Quantity

Please note any special features, temperature requirements, questions, etc.

Your e-mail address and personal information are confidential and will never be sold or given to anyone. That is our promise to you.

Name *
E-mail Address *	Job Title
Phone Number *	Company *
Location * City	State/Province
Country

Once submitted, you will receive an e-mail containing a copy of your completed form. If you would like to submit documents, please reply to the e-mail you receive and attach them.

For additional technical assistance, please contact James Pope, Applications Engineering Manager, at:
1-800-332-5000 (U.S. & Canada) or 315-332-7100 extension 676; or e-mail: .