To facilitate processing your request, please fax this page to our Product Specialists.
To: Marketing Dept.
Texas Instruments
Attleboro, MA 02703
From ________________________________________________________
Company_____________________________________________________
Address______________________________________________________
Phone _____________________
Phone:
(508) 236-3192
(508) 236-1894
Fax _______________________
Fax: (508) 236-2349
The following information will help us determine the correct thermostat design for your application. You
may refer to the charts on pages 2 and 3 for assistance.
Request: Pricing _____________________________ Application Assistance _________________________
Description of Application ______________________________________________________________________
Estimated Annual Usage _______________________________________________________________________
Automatic Reset_______ MR________ MR-TF________ SPST________ SPDT________ DPST________
Open Temperature ____________________________ Maximum Tolerance ___________________________
Close Temperature ___________________________
Maximum Tolersnce ___________________________
Temperature Exposures: Maximum __________________________ Minimum _________________________
Location With Respect to Heat Source ___________________________________________________________
Temperature Transfer Medium (air, metal surface, etc.)_____________________________________________
Type of Heat Source:
Convection _____________ Conduction ____________ Radiation ____________
Electrical Requirements: __________________ Amps @ _________________ Volts; AC or DC ___________
Resistive ___________________ Inductive ___________________* Capacitive ___________________*
Tungsten Filament __________________ Milliamp _________________ Pilot Duty _________________
*If inductive or capacitive, indicate power factor __________________________________________________
(If available, please send copy of electrical / plumbing diagram).
Switch Termination (type and angle)_____________________________________________________________
Flange (type and angle of rotation) ______________________________________________________________
Enclosed or Exposed Disc ______________________________________________________________________
Environment (dust, lint, chemical fumes, etc.) ____________________________________________________
_____________________________________________________________________________________________
Agency Approvals _____________________________________________________________________________
Printed in U.S.A.
Reprinted 4/2002
MCGS011A
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