To use this form, fill in the necessary details and submit it directly to our sales team by clicking the submit button on the bottom of the page. The information that you supply will help us to accurately identify the exact lamp required for your system.

Company Name (*)

Please type your full Company Name.
Street Address (*)

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Country (*)

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Phone (*)

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UV System Manufactured by (*)

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Lamp part number (*)

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Lamp Current (*)

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Socket, Metal or Ceramic (*)

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Shoulder Length (*)

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Diameter (*)

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Lead Length E2 (*)

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Additional Information

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Contact Name (*)

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City. State, Zip Code

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Fax (*)

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E-mail (*)

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UV System name (*)

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Lamp Voltage (*)

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Lamp Power (*)

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Total Length (*)

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Arc Length (*)

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Lead length E1 (*)

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Type and Size of Termination (ie.—Spade, Ring, #8,#10) (*)

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