Fax No.
Email Address
Address
State
Ph.
Fax No.
Cell
Located U.S.
N
City
Contact Information
Specifications Information
State
Zip
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Y
Type of Application
Industrial
Commercial
Telecom
Other Application
Critical ???
Y
N
Location:
Indoor
Outdoor
Partially Covered
Coastal or Offshore
Tropical
Pressurized Building
Ventilated Building
HVAC Building
Ambient Operating Conditions:
Temperature (°F)
Min
Max
Relative Humidity (%)
Min
Max
Altitude (ft Above Sea Level)
Earthquake Seismic Zone
Questions / Comments:
Project Name
Company End User
Contractor
Main No.
Contact
Date
The Real Power
Is
Knowledge!

Double Check All Information Before Submitting!
Copyright © 2006
POWER SOLUTIONS LLC
* Authorized LTI UPS Factory Representative For All Texas ! 
* Experience and Quality - Call Us Today!
713-385-5009 / 281-556-0380
Fax: 281-556-0380
Batteries located in same building as UPS:
Y
N
DIEBOLD
Total number of jars
Number of jars in each string
Voltage of each Jar
UPS
Referred By:
UPS Brand Name
Number of parallel strings
Wall mounted
Y
N
Other Mounting
Type of communication:
Longest wire run from enclosure to batteries (In feet)
Battery model number, if known:
Battery manufacturer
Battery Type
Sealed
Flooded
Input power to Battery Testing / Monitoring System
volts
AC
DC
Dry contact
RS232
Modbuss
Other:
Other
Need A Quote?

Email It To:
fdiebold@sbcglobal.net
Automated Battery Testing and
Monitoring System Submission Form
NEVER GET CAUGHT WITH YOUR BATTERIES DOWN!


Type of batteries to be used for standby time:
Sealed
Flooded
10 year
20 year
Specific brand name (if required):