Customer Questionnaire

Company Name*

Company URL*

Name*

Title*

Address*

Street Address Address Line 2 City State ZIP Code

Phone Number*

Contact Email Address*

What is your application and how do you plan to use the Powercast products?*

Is your application for the Powercast products battery recharging or is it battery-free?*

Do you require continuous or intermittent (pulsed) power?

Currently, what Powercast products are you using?

How much average and peak power do you need?

What output voltage do you require from the harvester?

What will be your RF source for power? ie: Powercast's TX91501?

What type of receiving antenna are you planning on using?

What is the desired distance from the source to the harvester (range)?

Is this an industrial, commercial, or residential application?*

What is your expected sales volume: Year1, Year2, and Year3?

What is your timeline for your project to begin and end?

How did you hear about Powercast?*

Name

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