Doc. No.

KEPL-MKT-05
Rev. No. '00
New Product Order Form Rev. Date 00.00.0000

Iss. Date 14.06.2023

Customer Name: ______________________________________ Date: _______________

Product Description: _______________________________________________

Branding on PCB: Yes [ ] No [ ] Brand Name_________________

IP Rating: IP20 [ ] IP65 [ ]
LED Type: 2835 [ ] 5050 [ ] 5050RGB [ ] 2835CCT [ ] 5050RGB + 2835CCT [ ]
LED Make: ___________ Led Lumens: ___________ Led Wattage: _________ CRI: ________
LEDs per Meter: 30[ ] 54[ ] 60[ ] 90[ ] 108[ ] 120[ ] 168[ ] 180[ ] 240[ ] other_________
Voltage: 220V [ ] 12V [ ] 24V [ ] Length: _________
PCB Type: Single Side [ ] Double Side [ ] PCB Color: White [ ] Brown [ ]
PCB Thickness: 18+25um [ ] 18+35um [ ] 18+50um [ ] 18+70um [ ] 25+25um [ ] 35+35um [ ]
Required Wattage/Meter: __________ Required Wattage/5 Meter: __________
CCT/ Color: _________ _________ _________ _________ _________
Connector Type: DC Wire [ ] IP20 Conn [ ] IP65 Conn [ ] RGB Conn [ ] ________________

Adhesive Tape: 91031 3M White [ ] 3M Brown 467[ ] Other [ ] ______________

Spool: 100mm [ ] 130mm [ ] 150mm [ ] 177mm [ ] 255mm [ ]
RGB Controller: Yes [ ] No [ ] SMPS Req: Yes [ ] No [ ]
Packaging Type: Industrial [ ] Blister [ ] Antistatic Bag [ ] Antistatic Bag + Mono carton [ ]
Mono carton [ ]
Art card [ ] / Backcard Type [ ]: No [ ] Printed [ ] White [ ]
Antistatic + Mono Carton Type: No [ ] Printed [ ] White [ ]
Bopp tape : Transparent [ ] Printed [ ] Brown[ ]
No of Units in Inner: 10[ ] 20[ ] 25[ ] 50[ ] Other_______________

Outer: No [ ] Yes [ ] No of Units in Outer_______________

Remarks:

Other Accessories: For IP20- _____________________

For IP65: HS Sleeve [ ] Silicone Tube [ ] Silicon Clamps [ ] Screw [ ]
For HV Flex- No of Rectifiers__________ No of Clamps________________
No of End Caps____________ No of Screw_______________
Glue________________ Loop in Conn________________

Labels : Spool Label [ ] Back card/Art card/Antistatic label [ ] Mono [ ] Inner Label [ ]
Outer label [ ] Rectifier[ ] Warning [ ]

For Rectifier Kit- No of Rectifiers__________ No of Clamps________________

No of End Caps____________ No of Screw_______________
Glue________________ Loop in Conn________________
No of Units in outer:______________

Name: _____________________ Sign: _____________________