Please Complete as much of this form as possible for proper cross-reference.

Items in GREEN indicate required information.

Contact Information
Name:
Company:
Telephone:
Fax:
E mail:

	Lamp Details
	Curing System Manufacturer :
	Lamp Manufacturer :
	Lamp Part Number:
	Watts Per Inch::		WPI
	Lamp Voltage :		Volts
	Lamp Current :		Amps
	Lamp Wattage:		Watts
	Measurement Units :	inches mm
	Total Overall Length:
	Arc Length:
	Quartz Diameter :

SIDE A			SIDE B
End Fitting:	other C1 C2 C3 C4 C5 C6 C7 C8 C9 C10 C11 C12 C13 C14 C15 C16 C17 C18 C19 C20 C21 C22 C23 C24 C25 C26 C27 C28 C29 C30 C31 C32 C33 C34 C35 C36 C37 C38 C39 C40 C41 C42 C43 C44 C45 C46 C47 M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12 M13 M14 M15 M16 M17 M18 M19 M20 M21 M22 M23	Click Here To See End Fittings	End Fitting:	other C1 C2 C3 C4 C5 C6 C7 C8 C9 C10 C11 C12 C13 C14 C15 C16 C17 C18 C19 C20 C21 C22 C23 C24 C25 C26 C27 C28 C29 C30 C31 C32 C33 C34 C35 C36 C37 C38 C39 C40 C41 C42 C43 C44 C45 C46 C47 M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12 M13 M14 M15 M16 M17 M18 M19 M20 M21 M22 M23
Lead Length:		Enter '0' If No Wires	Lead Length:
Connector:	none A B C D E F other	Click Here To See Connectors	Connector:	none A B C D E F other