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Company Info: |
| Company Name:
_____________________ |
Contact Name:
______________________ |
| Phone #:
___________________________ |
Fax #:
_____________________________ |
| Email:
_____________________________ |
Site URL:
__________________________ |
|
Required information: |
| Qty: ________ |
|
| Amps: _________________ |
Volts: ____________ |
| Overall length: ___________ inches |
Arc length: _________ inches |
| Watts per inch: __________ |
Ozone free? Yes / No |
|
Helpful information: |
|
equipment manufacturer: ___________ |
Model: ____________________________ |
| Lamp part #: _____________________ |
Fax to (616)
669-7704 |
| Please identify and check the appropriate end fitting that you
require. After filling out this form as completely as possible please
fax it to (616) 669-7704. We will keep a record of your order to
simplify and speed future orders. If you lamp does not match the above
standards we will probably still be able to provide your lamp, though it
may be necessary to send us a sketch or a burned lamp to identity the
proper type. If you need help just call us at (616) 669-164 |