Email: contact@nancylitchfielduv.com.au Ph: 61 - 03 9727 0977   Fax: 61 - 03 9727 0277

	Infra Red Lamp Quote Request Form
	To help us identify the correct IR Lamp that you require, please submit as much of the information below as possible. If most of this information is unavailable, a few digital photographs would help us to identify your lamp, providing it shows: * The overall lamp * A close up of the End Cap * A close up of the Filament
	Lamp Manufacturers Name ?
	Lamp Ref./Part Number ?
	Lamp Voltage (printed on End Cap) ?
	Lamp Wattage (printed on End Cap) ?
	Lamp Total Overall Length (End cap to end cap excluding the lead wires) ?
	Lamp Width ?
	Lamp Heated Length ?
	Lamp Wave Length ?	Short Wave Medium Wave
	Lamp Type ?	Single Tube Twin Tube
	Lamp Reflector Backing ?	No Reflector Backing Gold Reflector Backing White Reflector
	Lamp Connection ?	One Sided Two Sided
	Lamp Wire Configuration ?
	Lamp Wire Length ?
	Lamp End Connectors Required ?	or Bare Wires
	Lamp Position in Machine ?	Horizontal Vertical
	Additional Information ?
	Your Name ?
	Title ?
	Company Name ?
	Company Mailing Address ?
	Phone Number ?
	Fax Number ?
	Email Address ?
	Print or Save this Request Form: Click Here