Date

Company name*

Contact person

E-mail*

Purchase order number*

First name

Last name

Position terminal ?
—Please choose an option—PresentNot present

Wire Section

Position Double Crimp (if needed)
None

Is the carrier strip to be cut? ?

Is the seal to be crimped?
NoYes

Is it going to work into an automatic stripper?

Is it going to work with a stripper?

Micrography
NoYes

Capability report
NoYes

Thank you for filling in this form.

Do you have other remarks?

Please send samples to SMANS – Bremheidelaan 6, B-2300 Turnhout

Note: delivery time only starts once Smans has received samples and purcharse order.

Please add:
- 2 meters of cables of each terminal
- 200 terminals on reel
- Optional: housing and seals