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			Ref. No.                                                                  Date : ■ User Name : ______________________________ ■ Address : _________________________________________________________________________ Tel. No : ________________________ Fax No : ______________________________ ■ Name of Person in Charge : __________________________ ■ Requirement : [ □ Protector, □ Controller ] [□ Normally Close, □ Normally Open ]                Opening Temp. _______ ± _______ ℃ ( at no load )                Closing Temp. _______ ± _______ ℃ ( at no load )                Opening Temp. _______ ± _______ ℃ ( at actual load )                Closing Temp. _______ ± _______ ℃ ( at actual load ) ■ Application : For use of ____________________________________________________________                Rating □ AC, □ DC _______ V _______ A Power Factor _________ % ■ Mounting : Position _______________________ Method ________________________________ ■ Required Life : __________ Cycles ■ Kind of Load : [ □ Resistive, □ Inductive, □ Motor, □ Solenoid, □ Lamp, □ Other ] ■ Vanish : [ □ No, □ Dipping, □ Vacuum impregnation ] ■ Environment : Corrosive Gas ( ) , Humidity ( ) , Vibration ( ) ■ Heat Proof : Continuous : _______ ℃, Overshooting : _______ ℃/min ■ Cooling and Heating Cycles : _______ + _______ ℃ / - _______ ℃ _______ Cycles ■ Applicable Standards : [ □ UL, □ CSA, □ VDE, □ ETC. ] ■ Lead Wire : L1 _________ mm, L2 _________ mm ■ UK Ucera's Model No.: [ □ UK-31 , □ UK-32 , □ Other ] ■ UK Ucera's Rating : AC 125V _______ A ( Resistive Load ) OR [__ ] [__ ] V _______ A ■ Current Usage Type : Brand Name _________ Type __________ ■ Sample Requirement : Quantity _______ Delivery ____________________________________ ■ Mass Production Schedule : ______________________________________________________ ■ Mass Production Lots : _________ K pieces/month Target Price : ____________________ Upon receipt of your information, we will furnish you with the more detailed data such as the technical specification and price. Kindly satisfy your data as possible as you can.