ISSPRO CR Request Form

* Required fields

Basic Information

Company Name*

Address*

City, State, ZIP*

Contact Name*

Contact Title*

Contact Email*

Contact Phone*

Contact Fax (optional)

Would you like to add an additional contact?

Shipping Information

Packaging Requirements

Shipping Requirements

Upload Additional Documentation

Product Timeline

Client Production Date (MM/YY)*

Estimated Annual Usage*

Will you require prototypes?*

Amount Required*

Quality Requirements

Quality Manager Name*

Quality Manager Email*

Quality Manager Phone*

Quality Manager Fax (optional)

Quality Docs Required (Ctrl + Click to select multiple) *

Specify Other*

PPAP Required?*

PPAP Level*

Upload Reference Document

Mechanical Requirements

New Design or Modification of an Existing P/N?*

Client Part Number (TBD if unknown)*

Sender Length *

Sender Units *

Fluid Usage (Ctrl + Click to select multiple) *

Fluid % (Specify if multiple types)*

Fullest Point*

Is this a Pressurized Tank?*

Empty Point*

Mounting Bolt Pattern*

Specify Bolt Pattern*

Mounting Fasteners*

Specify Mounting Fastener:*

Cap Profile Selection*

Fluid Movement Through Cap*

Sender Output Requirements

Connector PN*

Connector Type*

Harness Length*

Specify Connector Type*

Connector Mfg/Supplier

System Voltage (Integer or Range)*

Sender Output*

Sender Alarm Levels (N/A if No Alarms)*

	Signal	Wire Color	Connector Cavity Position
	Sender (Voltage In)*
	Voltage Output
	Ground*
	Alarm

Additional Information

Upload Additonal Documentation (Tank Drawings, Pinout Diagrams, Reference Documents)

Any Additional Comments