Company name

:

Address

:

State

:

City

:

Zip/ Postcode

:

Country

:

Telephone

:

-

Fax

:

-

Contact Person

:

Designation/ Position

:

E-mail Address

:

* Quantity

* Initial Information Required For Sizing

* Application

* Resistance in Ohm

* Maximum braking power in Watt

* Braking Cycle or time ON/ time OFF