Industrial Lamp
Quote Request Form

Company Name
First Name
Last Name
Address 1
Address 2
State Zip
E-Mail Address
Fax Number

Enter make and
part number if known

Make of the Lamp

Lamp Part Number

If you do not know the make and part number
or need a special lamp please
fill out any required parameters on the form below:

Custom Lamp Info

Lamp Type Envelope


Arc Length (A) Overall Length (B) Diameter (C)
Left Lead Length Right Lead Length

Fitting Style

-2S -3S -4C -5C -6C

Lamp Specs

Watts inch/cm

Lamp Wattage

Lamp Amperage

Open Circuit Volts

Operating Volts

Lamp Serial Number

Quantity required for Prototype Prototype Timing
Quantity required for Production Production Timing