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Cosense Inc.
155 Ricefield Lane
Hauppauge, NY 11788-2007
Phone No. 631-231-0735
Fax No. 631-231-0838

APPLICATIOIN QUESTIONNAIRE
"PEEL & STICK" DISPOSABLE MOUNT
LIQUID LEVEL SWITCH
SL-630 SERIES

Rep Name:
Customer:
Address:
City, State, Zip:

Date:
Phone:
Fax:
Email:

Number of Units to be quoted:

Potential number of units:

Delivery Expected:

Prototype at no charge, if number of units exceeds 100.

CONTAINER/APPLICATION INFORMATION
1.	Container Inner Diameter
2.	Container Outer Diameter
3.	Container Material
4.	Type of Liquid
5.	Operating Temperature Range
6.	Input Power: 5VDC-24VDC
7.	Output: TTL (High-Dry Condition), Source Current (Dry Condition), Sink Current (Dry Condition), Loop Power, 1 AMP Dry Relay Contact (Special)
8.	Sensor mechanical dimensions/form factor/envelope (specify any special requirements)
9.	Sensor mounting arrangement (specify any special requirements)
10.	Cable length 12" (305mm) standard, specify if different length required
11.	Containers smaller than 2" (50.8mm) diamter, specify diameter
12.	Are there any obstructions in container?
13.	Special call 1-800-456-9994, fax: 631-231-0838 or email: sales@cosense.com