CONNECTOR A

GENDER: MALE[   ] FEMALE[   ]

CONNECTOR TYPE:
(Circle One:)
1 DB9
2 DB15
3 DB25
4 DB37
5 DB50
6 15-Pin High Density
7 36-Pin Centronics
8 50-Pin Telco
9 RJ-11 4-Wire
10 RJ-11 6-Wire
11 RJ-45 8-Wire
12 DEC MMJ
13 M-50
14 M/34 (V.35)
15 50-Pin Berg
16 Spade Lugs, Lengths:
17 Other______________________

SPECIAL INSTRUCTIONS
(Circle Options:)
18 One End Cut
19 Pins Only
20 EMI/RFI (Plastic if not Specified)
21 Thumbscrews
22 Screwlocks:------Male------Female
23 90 Degree Hood
---Specify Cable Exit:______________
24 Pairing
25 Flying Leads, Length:___________
26 Label:____________________
27 Other------Please Attch Specs

DRAIN WIRE
(Circle One:)
(Applies only to Foil Shielded Cables)
28 Cut Drain Wire
29 Pin Drain by Itself---PIN#_____
30 Wrap Drain w/conductor---PIN#___
31 Attach Drain to Shell

QUANITIY: ______________________

PART NUMBER: ___________________

PRICE: ________________________

DELIVERY:

_______________________________

COMMENTS:

_______________________________

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_______________________________

_______________________________

_______________________________

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      P I N O U T     

 A                 B
 Pin#   Connector  Pin#

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CONNECTOR B

GENDER: MALE[   ] FEMALE[   ]

CONNECTOR TYPE:
(Circle One:)
1 DB9
2 DB15
3 DB25
4 DB37
5 DB50
6 15-Pin High Density
7 36-Pin Centronics
8 50-Pin Telco
9 RJ-11 4-Wire
10 RJ-11 6-Wire
11 RJ-45 8-Wire
12 DEC MMJ
13 M-50
14 M/34 (V.35)
15 50-Pin Berg
16 Spade Lugs, Lengths:
17 Other________________________

SPECIAL INSTRUCTIONS
(Circle Options:)
18 One End Cut
19 Pins Only
20 EMI/RFI (Plastic if not Specified)
21 Thumbscrews
22 Screwlocks:------Male------Female
23 90 Degree Hood
---Specify Cable Exit:______________
24 Pairing
25 Flying Leads, Length:___________
26 Label:________________________
27 Other------Please Attch Specs

DRAIN WIRE
(Circle One:)
(Applies only to Foil Shielded Cables)
28 Cut Drain Wire
29 Pin Drain by Itself---PIN#____
30 Wrap Drain w/conductor---PIN#_____
31 Attach Drain to Shell

COMPANY:

_____________________________

NAME:

______________________________

TELEPHONE:

______________________________

FAX:

______________________________

SIGNATURE:

______________________________

DATE:

______________________________