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Electronic Circuit Breaker Request Form (fill in all with •)

Manufacturer Catalog #   Model #
• Trip Type Trip Catalog #
• Trip Functions (if applicable)
• Rating Plug Amperage (if applicable)
• Drawout or Stationary Mount • Electric or Manually Operated  
• If Electric, What Voltage AC or DC
• Remote Close? Voltage AC or DC
• Shunt Trip? Voltage AC or DC
• UV Release?   Voltage AC or DC
• Aux, Switch(s)? Voltage AC or DC
• Bell Alarm?   Voltage AC or DC

Final Step