Online Information Order Form

This form does not place an order with Steck Connections. It is to be used as an information gathering tool. The sixteen questions below allow us to direct your request to the right people and product for your job.

Please fill in as many questions as possible or that pertain to your specific connector requirements.

Your name

Your e-mail address

Company name

Connector Sourcing Data

1. Device manufacturer
(if available)

2. Manufacturer's part numbers
(if available)

3. Current requirements/information

4. Amperage required

5. Voltage required

6. Number of contacts

7. Is one of the above to be grounded to shell hardware

8. Contact size/wire gauge (awg)

9. Plug hardware required

10. Plug hardware combination

11. Total number of plugs required

12. Receptacle hardware required

13. Recepticle hardware combination

14. Manufacturer's part numbers
(if available)

15. Total number of receptacles required

16. Other Comments


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