Modified Enclosures

First Name*

Last Name*

Company

City

State or Province-- Please Select --Outside US / CanadaAlabamaAlaskaAmerican SamoaArkansasArizonaCaliforniaColoradoConnecticutD.C.DelawareFloridaGeorgiaGuamHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMaineMarianasMarshall IslandsMarylandMassachusettsMichiganMicronesiaMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWisconsinWest VirginiaWyomingMilitary AmericasMilitary Europe/ME/CanadaMilitary PacificAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Territory

Country*--please select--CanadaUnited States

E-mail*

Business Phone

Project Name*

Date*MM/DD/YYYY

Distributor Name and Location (city, state)*

Distributor B-Line Account #

Rep. Agency

RequestNew RequestChange of Existing Part

Drawing Included?YesNoPlease e-mail drawings to CHBLPricing@eaton.com

Purchase Quantity*

Annual Quantity

Closest B-Line Part #, Existing Modified Part #, or Competitor Part #*

Competitor(s)

Rating*-- Please Select --NEMA 1NEMA 3NEMA 3RNEMA 4NEMA 4XNEMA 6PNEMA 12NEMA 13

Certification*-- Please Select --ULcULCSANot Required

Target Price

Dimensions Height

Dimensions Width

Dimensions Depth

Material-- Please Select --Carbon Steel304SS316SSAluminumGalvanized

Special Paint RAL #Special RAL#Other Custom Paint Request (paint chip sample required)Mail Eaton Paint Chip sample toSpecial Options

Paint chip provided?YesNo

Additional Paint Comments

Desire holes and/or cutouts to ease installation

List those that apply

Desire catalog accessories pre-installed by Eaton's B-Line Division

Please list all accessory options that apply

Catalog Accessories (i.e. panel, window kits, louver kit, etc.)

Please list all required accessories that are not pre-installed

Additional Requirements

Drawing number