Product Safety Request For QuoteContact Full Name(Required)Company Name(Required)PhoneEmail(Required) Enter Email Confirm Email Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Are there specific security requirements such as NIST, ITAR, or FARS that your job must follow?YesNoPlease explain the security requirements for your job.(Required)Do you plan on importing your product into other countries?YesNoWhat countries do you plan on importing your product to?Services Requested(Required) Certification Pre-Compliance Consultation Custom Testing OtherIf OtherUnit DetailsUnit Name(Required)Model NumberDevice Description For Informational Use(Required)Brief Description, Indoor-Outdoor Use, etc.Intended Market or Certification Type(Required) Australia Brazil Canada China European Union Japan Korea United States OtherIntended Use(Required) Residential Commercial Industrial Medical Laboratory OtherIf Other Intended MarketIf Other Intended UseProduct Services Requested(Required) Info. & Comm. Technology Laboratory Medical UnsureUnit Operating Voltage/Current/FrequencyRequested Standards for Evaluation(Required)Medical Specific InformationClassification(Required) Stationary Fixed Portable Body-worn Mobile Hand-held Class I Class II Internally Powered USB PoweredDo you require a Software review of clause 14 and IEC 62304?Yes / NoYesNoUnsureDo you require a Risk Management review of ISO 14971:2019?Yes / NoYesNoUnsureDo you require a Usability review of IEC 60601-1-6 and IEC 62366-1?Yes / NoYesNoUnsureDoes your product have alarms incorporated into the medical device 60601-1-8? Information signal Low priority alarms Medium priority alarms High priority alarms N/AWill your product be used in a home health care environment 60601-1-11?Yes / NoYesNoDoes your product use batteries?Yes / NoYesNoIf yes: What Kind of Battery? Is the Battery Certified?Does your product incorporate the use of a laser 60825?Yes / NoYesNoUnsureDoes your product incorporate the use of LEDs as luminaires/lamp IEC 62471?Yes / NoYesNoUnsureHome Health CareTransit OperableYesNoUnsureUnit of MeasurementInches / PoundsMillimeters / KilogramsLengthWidthHeightWeightAmbient Temperature Range (°C)Ambient Humidity range (%)Atmospheric Pressure Range (kPa):
