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Contact Information:
 Name
Title / Position
 Company
 Address
 City
State
 Zip Code
Country
 E-mail
 Phone
Fax
Date Required
 
 Cable Information:
 Number of Pairs
Number of Conductors
 Pair Lay
Binder Tape
 Cable Lay    
 
 Conductor Information:
 Conductor Size
 Solid
 Stranded
 
 Insulation Information:
 Material
 Wall Thickness
 O.D.
 
 Shield Information:
 Shield Type
 Braid Coverage
(Minimum %)
 Binder Tape
 Braid Plating
 
 Jacket Information:
 Material
 Color
 O.D. (Maximum)
 Wall Thickness
 
 General Cable Information:
 Voltage Rating
 Temperature Rating
 Nominal Capacitance
 Nominal Impedance
 Quantity (in feet)
 Reel Put Ups (in feet) 
 Minimum Length
(in feet)
 Approval(s) Required
 Color Code
 Special Jacket Print
 
 Any special requests or additional comments:
 

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