The purpose of this form is to clarify your ballasts needs. It is by no means complete but we need to start somewhere. We understand that specifying ballasts might not be your cup of tea so don't hesitate to contact us for help.

* The form will be sent only if the fields with an asterisk are filled.

1.0	GENERAL INFORMATION
	Company name :
	Project name :
	Person to contact : *
	Email : *
	Annual quantity :
	First delivery forecast:
2.0	INPUT VOLTAGE TYPE
	DC input
	AC input
3.0	INPUT VOLTAGE RANGE
	Minimum operating voltage :
	Nominal operating voltage :
	Maximum operating voltage :
4.0	LAMPS SIZE OR TYPE / WATTS
	T5/16mm
	T8/26mm
	T12/38mm
	CFL
	UV
	Quantity of lamps per ballast :
	Lamp mfr. p/n :
5.0	LAMPS OPERATION MODE
	a - Rapid start (bipin) b - Instant start (single pin) c - 4 pin d - 2 pin e - Other - please describe :
6.0	BALLAST OPERATING TEMPERATURE RANGE
	°C	Minimum
	°F	Maximum
7.0	MECHANICAL REQUIREMENTS
	Micro European North American Open frame Other If you chose "other": Housing maximum size inch length : mm width : height :
8.0	ELECTRICAL CONNECTION
	.250'' (6.35mm) quick disconnect terminal Header, connector on ballast Wires
9.0	COMMENTS In your words, what do you expect from the ballast?