Please download this sample request form and fill it to send us by fax.

To: UCHIYA THERMOSTAT CO., LTD.                    Date(month/day/yr):                    

Fax : 81-489-56-1310 ( Marketing Div.)          Ref. No. (for your use):             

  

Sample Request Form
(Thermoswitch)
  

Company:                            Div/Dept:                        Requested by:                 

Tel No.:                        Fax No.:                          E-mail:                        

Address:                                                                                           
  

Automotive model No.to be installed:                                                          

Application:                                                                                   
  

Thermoswitch function: □Temperature control   □Overheat protection

Electrical ratings:            VDC             A

Ambient conditions for use;: Min.- Max.Temp.         -         degC     Normal temp.         degC

Contact system:   □ Open circuit on temperature rise (normally closed)
                   □ Close circuit on temperature rise (normally open)

Temp spec. (at no load): operating        +/-      degC   resetting          +/-       degC

                                                         or differential          +/-      degK

UCHIYA model No:           Sample quantity required:      pcs  Sample required date:              

Reference information (such as competitive product):                                           

Production: schedule                         production quantity            pcs/month

Quotation: □need  □no need

Other request: