Expedite To: Laurel Industries Fax: 847/432-8243
From: Contact Name: ____________________________________________________
Company: ________________________________________________________
Address: _________________________________________________________
City: ____________________________State/Province _____________________
ZIP/Post Code: _____________________ Country: _______________________
Phone: _______________________ Facsimile: ___________________________
E-Mail: __________________________________________________________
I Application:___________________________________________________________
___________________________________________________________________
II We can offer a competitive bid for an optical element you are now purchasing. Please advise the part number number and description:
____________________________________________________________________
III Complete this questionnaire which will allow us to design a lens to meet your precise requirements economically.
Lens:
For Infinite-Object Systems:
1. Focal Length (EFL): ______________________________________________
2. Semi-Angle: __________________ or Image Format: __________________
For Finite Systems:
1. Object-to-Image Distance: _________________________________________
2. Object Format: __________________________________________________
3. Magnification: ___________________________________________________
Wavelength Range:
Visible:____________________ Ultraviolet: ____________________
Infrared: ___________________
Laser Wavelength: ____________________
IV If there is a working drawing already prepared, then please fax and mail a hard copy for our review to Laurel Industries, 280 Laurel Avenue, Highland Park, Illinois 60035-2620 USA.
V. Quantity: _____________________________________________________________
VI. What is your industry? __________________________________________________
VII. This inquiry is: ___ Immediate ___ Information Only
___ Future Requirement in ___ months
Any Questions? Please call us at 847/432-8204.
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