Request for Quotation Worksheet
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Name:*		Email:*
Company:*		Phone:*
Address:*		Preferred CCH Distributor:
City:*
State:*		Zip:*
Manufacturer & P/N:
Panel Type:	N/A Simplex Duplex Triplex Other	Enclosure Type:	N/A NEMA 1 NEMA 2 NEMA 3 NEMA 3R NEMA 4 NEMA 4X NEMA 7 NEMA 12 Other
Hazardous Area/Zone:	N/A Class 1, Div. 1, Gr. B,C,D Class 1, Div. 2, Gr. B,C,D Class 1, Div. 1, Gr. C,D Class 1, Div. 2, Gr. C,D Zone 1, IIC Zone 1, IIB Zone 2, IIC Zone 2, IIB Other	T-Rating:	N/A T1 T2 T3 T4 T5 T6 Other
Power Configuration:	N/A Non-Combination Motor Protector Fusible Disconnect Circuit Breaker Molded Case Switch Molded Case Switch w/ Fuse Block Other	Material:	N/A 316 Stainless Steel 304 Stainless Steel Cast Aluminum Aluminum Painted Steel Non-metallic Krydon Fiberglass Other
Starter Type:	N/A Full Voltage Non-reversing Reversing Reduced Voltage Soft Start Star Delta Multi-speed Other	Line Voltage:	N/A 120V - Single Phase 220V - Single Phase 240V - Single Phase 200V - Three Phase 208V - Three Phase 220V - Three Phase 240V - Three Phase 380V - Three Phase 400V - Three Phase 415V - Three Phase 480V - Three Phase 600V - Three Phase Other
Short Circuit Rating:	N/A Not Specified 10K AIC 25K AIC 42K AIC 50K AIC 65K AIC 100K AIC Other	Preferred Device Brand:	N/A Cutler-Hammer Allen Bradley Square D GE Siemens Other
Horse Power:	.5    1.5 5     15    30    60    125     Other    .75  2    7.5  20    40    75    150    1     3    10   25    50    100  200
Options:
	Alternator - MANUAL Alternator - AUTOMATIC Alternator - MANUAL / AUTO Run Indicators Elapsed Time Indicators Alarm Indicator Horn Lightning Arrestor Auxillary Contacts Hand - Off - Auto Mounting Pan Hinges Cntrl Pwr Transformer   Prim & Second Protection		Phase Monitor Heater Breather Drain 24 HR Time Clock Time Delay Relay Control Relay(s) Terminal Strip    Convenience Outlet Start / Stop Window Kit    Wiring Diagram(s)
	Conduit Entries:	Standard Drawing Supplied
	UL Listed 508A:	Yes No
	ATEX:	Yes No
	Additional Info: