20
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
17
18
19
21
22
23
24
25
Y
Type of Application
Industrial
Commericial
Telecom
Other
Other Explain
Critical ???
Y
N
Size of UPS (KVA) or Load
Input Voltage available
480Vac 3-Phase
Other
Output Voltage requested
120Vac 1-Phase
120Vac / 208Vac 3-Phase
480Vac 3-Phase
APPLICATION NOTE: If unit is over 50 KVA, 3-Phase output is suggested.
APPLICATION NOTE: If loads are all 1-Phase, suggest UPS 1-Phase Output.
Standby Battery Time needed at full load
Minutes
Or Load Profile
Type of batteries to be used for standby time:
Sealed
Flooded
If Sealed
10 year
20 year
Specific brand name (if required):
Sealed battery mounting:
Rack
In a Cabinet
Self Stacking (20 year Sealed)
Flooded batteries - Dimension Restrictions:
Width
"
Height
"
Depth
"
NOTE: If application is critical I highly suggest Automated Battery Testing and Monitoring Unit for the batteries!        
Standards
Built to UL 1778
NEMA
CSA Certified
USCG
DNV
System Input Neutral:
Grounded
Ungrounded
System Output Neutral:
Grounded
Ungrounded
Bypass AC Source
Common with Main
Seperate Supply
Bypass Switch in Separate Enclosure
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:
No Redundancy
Redundant
IEC
UL
Certified / Stamped
Automated Battery Testing and Monitor System:
Y
N
Project Name
Company End User
Contractor
Main No.
Contact
Date
The Real Power Is
Knowledge!

Double Check All Information Before Submitting!
Copyright © 2006
26
Battery Buss Voltage:
125 VDC
240 VDC
360 VDC
Please Choose The Best Battery Buss Voltage For The Least UPS System Price!.
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
Need A Quote?

Email It To:
fdiebold@sbcglobal.net
UPS Submission Form


DIEBOLD