Name:
Company:
Phone number:	Extension
E-mail
Fax number:	Customer application requirements
Part number, Model #	Or number of channels
Range: Transmitter - Receiver	In Miles, Km / Meter or ft
If Obstruction:	Type;  Threes, Building, Wall, What Material?
Transmitter with Solar power	# ON and OFF cycles during one week
Is Monitoring or alarm required	HI LO Alarm, Status, Please specify
Brief description control or operation  number of circuits
Type of application

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