Manufacturer Name*

Client Representative*

Title

Phone*

Fax

Email*

Description of Product
(what is it, what does it do, etc.)

If your product will be tested to military or aerospace standards, please disregard the rest of this form and press the Submit button.  (The remaining questions pertain to commercial products only.)  If your product is commercial, please continue.

Information Technology Equipment
Medical
Scientific (Laboratory), Test, Measurement
Industrial
Light Industrial
Other (None of the above categories apply)

North America
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Australia/New Zealand
Taiwan
Korea
China
Other (please specify in the table below)