Innergy Power

Ecotality

Battery Application User Form

Innergy Power stands ready to satisfy your energy requirements. For us to better serve your needs, please fill out the following checklist and click on the submit button at the end. We will contact you promptly to discuss the details of your application.

Please fill out all fields in this form - enter NA where not applicable

Applications Profile

Date submitted:

Sample date:

Production date:

Contact Information:
Company name:	Type:	Email:
Address:	City:	State:	Zip:
Main Phone:	Fax:	Website URL:
Technical contact name:	Title:	Phone:
Procurement contact name:	Title:	Phone:

Device Information:
Device Type:	Device description/function:
Device intended user:	Battery usage category: Float Cyclic
Expected battery cycle life:	Is this a new design? Yes No
If no, current battery type, nominal voltage, and capacity:
Other battery types evaluated:

Discharge Conditions:

Desired run time:

Operating voltage range: volts min to volts max

Discharge termination voltage:

Operating temperature range: ° F min to ° F max

Current range and mode:

If continuous: mA min mA ave mA max

If pulse: mA max msec pulse width Hz frequency

Charging Considerations:
Charge in device? Yes No	Charge with stand alone charger? Yes No
Charge control IC type:
Desired charge time: hours
Temperature range: ° F min to ° F max
Maximum charger supplied voltage: volts
Maximum charger supplied current: mA
Over temperature shut off provided? Yes No
Temperature compensation provided? Yes No

Mechanical Requirements:
Soft Pack Hard pack	Weight limit: ounces
Battery compartment dimensions (max): inch. L x inch. W x inch. H
Internal battery compartment tempurature range: ° F min to ° F max
Wire lead length: inches from pack attachment to connector.
Wire lead guage: AWG	Connector type and style:

Comments/Special Considerations:

Please fill out all fields in this form - enter NA where not applicable

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