Merrimac Multi-Mix PICO (TM) - Sample Request Form

41 Fairfield Place, West Caldwell, NJ 07006 • Tel: 973.575.1300

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Sample Request Form

To request samples of Multi-Mix PICO^TM Products, please fill out the following form, then hit the Submit Request button at the bottom of the page. Or e-mail: crm@merrimacind.com.

Name

required

E-mail

required

Information about the Company

Company Name

required

Mailing Address

required

Shipping Address

required

Phone #

required

Fax #

For what Application do you plan to use these Products?

Commercial
SATCOM
Military

Application description and screening requirements:
(required)

What is your potential volume or usage?
(required)

When will production begin?

When will sample testing be completed?
(required)

What Model# and Operating Frequency is required?
(required)

Model #	Operating Frequency	Number of ^* Samples
QHD-2Z-1.9G
QHD-2Z-2.1G
QHD-2Z-2.45G
QHD-2Z-5.5G
HJD-2Z-1.9G
CSD-10Z-1.9G
CSD-10Z-2.1G
CSD-20Z-1.9G
CSD-20Z-2.1G
CSD-10Z-2.45G
CSD-10Z-5.5G
CSD-20Z-2.45G
CSD-20Z-5.5G
ILC-3SH-2.0G
PDD-2Z-2.0G
PDD-3Z-1.9G

^* There is a limit of two samples per Model #. If you require more than two, please put an explanation in the "Special Requirements" box below

What power level are you operating at?
(required)

Are there other functions in your applications which
you would like to have integrated into a PICO MMFM?

Special requirements:

Sales

Merrimac Industries, Inc.

Tel: 1.888.434.MMFM - Fax: 973.882.5990
E-mail: pico@merrimacind.com