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A.  APPLICATION

1.  How will this potentiometer be used?  Voltage Divider Rheostat Other
2.  Will this potentiometer will be used in a military application?   Yes No
3.  Will this potentiometer be used in a commercial aircraft application? Yes No
4.  Will this potentiometer be used in an outer space environment?  Yes No
5.  Please briefly describe your application:

B.  MECHANICAL

1. Basic Configuration:

Linear Motion Potentiometer
Rotary Motion Potentiometer, Bushing-mounted
Rotary Motion Potentiometer, Servo-mounted
Rotary Motion Potentiometer, other
Rotary Element and Wiper Assembly
Linear Element and Wiper Assembly
Arc Segment Potentiometer
Other

2.  Mechanical Travel: inches MM Degrees

3. Will this potentiometer need to be custom designed to fit within any dimensional requirements of an
     existing system?  Yes No

4.  For circular body potentiometers, what outer diameter is desired?    inches MM Degrees

5. What type of termination is desired?  Lead wires Cable Connector Terminals

C.  ELECTRICAL

1.  Electrical Travel: inches MM Degrees
2.  Resistance (Total): +/- % Ohms
3.  Linearity: % Independent  Absolute
4.  Applied Voltage: volts DC AC
5.  Noise requirements:
6.  End Resistance: ohms, max.
7.  End Voltage: % of total applied voltage, max.


D.  ENVIRONMENTAL

1.  What is temperature range of your application?  °C to °C
2.  What are the rotational life cycle requirements? cycles
3.  Please list any other special requirements, conditions, or specs that
    may be important to your application:
    

E. OTHER

1.  How many pieces are desired?
2.  What is your target or budget price for this part?

Please list any other special requirements, conditions or specs that may be important: