Name * Phone * Email * Company * City/State * ZIP Code * Cable Assembly Type Complete Pig Tail Length of Cable Cable Type 40 AMP 60 AMP 100 AMP 200 AMP Other (Specify in Special Instructions Below) Special Instructions Connector 1 Size 28 32 44 52 Other (Specify in Special Instructions Below) Connector 1 Insert Configuration 02 03 04 05 06 07 12 13 Connector 1 Shell CD90555 CD90556 CD90557 CD90558 Other (Specify in Special Instructions Below) Connector 1 Pig Tail Style Open End Terminated Other (Specify in Special Instructions Below) Pig Tails Special Instructions Connector 1 Special Instructions Connector 2 Size 28 32 44 52 Other (Specify in Special Instructions Below) Connector 2 Insert Configuration 02 03 04 05 06 07 12 13 Connector 2 Shell CD90555 CD90556 CD90557 CD90558 Other (Specify in Special Instructions Below) Connector 2 Special Instructions Quantity Attach Print? Comments
