Sample Request Form

Please submit this completed questionnaire to obtain a free product sample.

(*) Required fields


Customer Information

    Designer's Name:  (*)
              Title: 
            Company: 
            Address: 
          Mail Stop: 
               City:  
     State/Province:  
    Zip/Postal Code: 
            Country: 
       Phone Number:  (*)
         Fax Number: 
      Email Address:  (*)

Shipping Information (If different from above)

               Name: 
            Company: 
            Address: 
               City: 
     State/Province: 
    Zip/Postal Code: 
            Country:    

Requester's information (If different from customer's information)

               Name: 
            Company: 
WWDW Reference Num.: 
       Phone Number: 
      Email Address:

Where did you find out about Power Trends? (*)

Application Information

I am working on

What is your Application?
What is your Project Name?

When do you need production quantities?

Approximately how many ISRs could you use on an annual basis?

Please select one of the following that best describes your application.

Computers Systems and Peripherals

Communications Systems and Equipment

Networking

Telecommunications

Wireless

Audio/Visual

Industrial Control, Robotics, or Test Equipment

Medical Electronic Equipment

Office & Business Machines

Avionics, Marine, Space & Military Electronics

Automotive and Other Ground Vehicles

Consumer Electronics & Appliances

Electronic Subassemblies (boards, modules, hybrids, power supplies)

Other Manufacturers of electronic equipment not described above

Independent/Academic R&D Laboratory

Technical/Engineering Consulting Firms

What type of IC's will you be powering?
Device Manufacturer and Part Number:

Would you like to receive a Power Trends' catalog?

120 page printed catalog
CD-ROM catalog

Comments

Please feel free to leave any additional comments in the area below.

Product Sample Selection

Tell us about your application's power requirements
Input Voltage: Volts	Output Voltage: Volts	Output Current: Amps	T_A: °C

Wide Input Range Products
Product Series	V_O/I_Omax	Package Style
PT4200
PT4300
PT4205
Product Series	Output Voltage	Package Style
PT3320
PT3340
PT5100
PT6100
PT6210
PT6300
PT78HT200
PT78NR100
PT78ST100
PT78ST200
PT79SR100

5V Bus Products
Product Series	Output Voltage	Package Style
PT5020
PT5040
PT5060
PT6400
PT6420
PT6500
PT6600
PT6900
PT6920	Dual Output: V_1out=3.3V Select V_2out
PT7600	Programmable +1.3V to +3.5V Order Sample
PT7705	Programmable +1.3V to +3.5V Order Sample
PT7749	Current Booster for PT7705 Order Sample
PT7770	Programmable +1.3V to +3.5V Order Sample
PT7746	Current Booster for PT7770 Order Sample