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    First and Last Name:

    Company Name:

    Company Address:

    Telephone:

    Fax:

    E-mail:

    Comments:

    1. Intended use of the battery: (draft, starting, plant protection, lighting, etc.)

    2. Information on the type of work regime:
    the battery works independently in relation to the consumerthe battery is in parallel mode in relation to the consumer

    3. Discharge current in exploitation [A]:
    a) Maximum current:

    b) Minimum current:

    c) Nominal current:

    4. Discharge time [h]:

    5. Required battery capacity [Ah]:

    6. Discharge voltage [V]:

    7. Temperature span of the battery use [°C]::
    a) Upper limit:

    a) Lower limit:

    8. Information on storage capacity [L x B x H mm]:
    a) in a vehicle:

    a) in a room:

    9. The manner of ventilating the room:
    NaturalArtificial

    10. Battery charging method:
    Charging with constant current I=constCharging with constant voltage U=constCharging with constant voltage and limited current (UI)Charging with increasing voltage and decreasing current (W)

    11. Charger + battery:
    Battery with additional branchBattery without additional branch

    12. Information on the battery that is replaced (if applicable)
    Type of electro-chemical composition:
    Ni-CdPb-PbO2
    a) Nominal voltage [V]:
    a) Battery capacity [Ah]:

    13. Special note of the buyer regarding the requested battery: