Custom Product Design Worksheet

Name:
Company:
Address:
City, State, Zip:
Country:
Phone:
Fax:
Email:
Web Site:
Project Name:
Project Description:
Electrical & Mechanical Requirements:

New Product? yes noModify Existing Product? yes no
Sample Available? yes no
Predicted Yearly Quantities:
Are there any electrical or mechanical specifications?
Electrical? yes noMechanical? yes no
Number of Samples Required:
Required Date:
Projected Annual Volume:
Target Price:
Packaging Requirements:
Application - How will the product be used?:
Indoor Outdoor Specific Location
Is funding for tooling available? $
Is funding for design development available? $
Design Specifications
Frequency:
Antenna Electrical Length:
1/2 Wave:
1/4 Wave:
Other:
VSWR:
Return Loss: -dB
Performance:

Gain dBi dBd
Equivalent to or better than sample (please provide).

Or
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1751 Wilkening Ct. Schaumburg, Illinois 60173 Email: customercare@antenex.com
Phone: 847-839-6000 Fax: 847-839-6035

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