If you're replacing an existing cell or battery pack, the following information will help us locate the appropriate product. You can submit this form by email or print this page, fill it out and fax it to us.


Please provide us with some information about yourself:
NICA will hold all contact information in confidence.
We will not release this information to any third party.

Your Name

Title

Company

Address

City

Province/State

Postal code /ZIP

Phone

Fax

Email Address

Battery Pack design and specifications:

Battery Pack Part #

Battery Manufacturer

Original equipment battery part #

Battery Chemistry

 

Battery Pack Voltage

Battery Pack Capacity

Battery Pack Dimensions

length cm
width cm
height cm

 

Quantity of cells in pack

Model # of cells
Manufacturer of cells

Dimensions of individual cells

length cm
width cm
height cm
Connector type
Packaging Type

 

Quantity

Date Required

 

Device Manufacturer

Type of Electronic Equipment
(Video Recorder, Toothbrush, computer...)

Device Model Number

Other Notes