New Lamp Quote Form

Contact Informations


First Name:		Company:
Last Name:		Division:
Title:		Mailing Address:
E-mail:		City:
Phone:		State/Province:
Fax:		Zip/Postal Code:
		Country:

Lamp Part Number
Equipment Manufacturer:		Application:
Equipment Model #:		Specify Unit of Measurement:	English (inches) Metric (mm)


UV Lamp Dimensions
1.Total Overall Length:	(inch/mm)	5. End Fitting	Metal Ceramic
2. Arc Length:	(inch/mm)		a (inch/mm)
3. Diameter:	(inch/mm)		b (inch/mm)
4. Cable Yes No			c (inch/mm)
Cable Length (in/mm) A B			d (inch/mm)
Cable Connector: Ring (diameter) No Ring

UV Lamp Electrical Information		Ballasts Electrical Data
Starting voltage	V	Secondary Voltage	V
Operating Voltage	V
Operating Amperage	A
Power	(w/inch or w/cm)

Purchase Qty.		Additional Comments:
Per Year
Per Order