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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 consumer the 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:
 Natural Artificial

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

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

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

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