The following is Coflex's technical assistance order form. This form can be printed for your specific technical measurements and descriptions then either mailed or faxed to Coflex, Inc.
Order Date:

Connecting Pads:

Figure Number:

Catalog Number:

Amp Rating:

Standard Tin Plate or Optional Silver Plate
(circle one)

Quantity:

Delivery Date:

Company Name:

Address:

City:State:Zip:

Phone:Fax:

Buyer's Name:
Coflex, Inc.
851 Route 6
Shohola, PA 18458
tel: 570.296.2100 • fax: 570.296.1111