Download Transmitter / Receiver Information request for providing testing / quote

Transmitter / Receiver Information Request
(for providing testing plan / quote)
* Denotes required information
*Contact Information
Name:
Company:
Phone No:
Fax No:
Email Address:
Street:
City:
State:
Zip Code:
*Equipment to be tested
Model Name/Number:
Serial Number:
Formal Name:
Equipment is:
*Intended market:
Receiver
U.S.
Transmitter
Canada
Transceiver
Other:
Emission Designator (if known)
Requested standards (if known) that apply to this device:
USA:
Canada:
EU:
Other:
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*Is the RF module purchased?
Yes
No
*If Yes, does the module have a FCC Modular Approval?
Yes
No
List the FCC ID#
Is a FCC Modular Approval requested?
Yes
No
*Define the intended use for this device:
*Does this device operate/tune over multiple channels?
Yes
No
*List all channels / frequencies used by the device under test:
Has this device been previously tested/approved to this or any other EMC standard?
Yes
IF ‘YES’:
No
Approval Number(s)
Date(s)
Issuing Authority
Power Source (DC):
Battery operated?
Nominal rated Voltage:
Minimum rated Voltage:
Maximum rated Voltage:
Power Source (AC):
Nominal rated Voltage:
Minimum rated Voltage:
Maximum rated Voltage:
Line Frequency:
Single or 3-Phase:
Maximum current:
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Receiver Specific:
*Nominal receive frequency (or tunable range)
*Receiver is:
superheterodyne
superregenerative
other:
Channel separation
*Maximum number of channels over which equipment can operate:
Transmitter Specific:
*Nominal transmit frequency:
*Equipment is classified as:
*Equipment has:
fixed
mobile
portable
hand-held
Integral antenna
Single antenna connector
Double antenna connector
*Type of antenna connector(s) (if equipped):
Antenna Gain (if known):
Method of frequency generation (crystal, Synth., other):
Transmitter Power:
*Rated output power at the antenna connector(s) (if equipped):
*Is the output power variable?
Yes
No
If ‘YES’:
What is the minimum RF power:
What is the maximum RF power:
Class of emission (if known):
Type designation:
Type of modulation:
What % :
*Can transmitter operate unmodulated ?
Yes
No
Is device intended for continuous operation (duty cycle = 100%):
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Yes
No
Should DLS take the required filing photos? (If not, you must provide these photos in
digital format before DLS can submit filing):
Yes
No
Is device intended for intermittent operation?
Transmit ON time (if applicable)
Transmit OFF time (if applicable)
Duty cycle = Tx ON / (Tx ON + Tx OFF) =
Yes
No
(if applicable)
*Is continuous operation possible for testing purposes?
What will be used for test? (Max. duty cycle possible)
Transmit ON time (if applicable)
Transmit OFF time (if applicable)
Duty cycle = Tx ON / (Tx ON + Tx OFF) =
Yes
No
(if applicable)
Does the device have a port for an input modulation signal? _
If ‘YES’:
Input signal level
Input signal impedence ()
Type of modulation
Percent
Audio limiting?
Maximum modulation depth
Yes
Extreme temperature range over which the equipment is to be tested:
Category 1: -20 C to +55 C
Category 2: -10 C to +55 C
Category 3:
0 C to +55 C
(General)
(Portable)
(Normal indoor use)
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No