DIRTECH

CUSTOMER’S REQUEST
COMPANY DETAILS:

Company name: Contact name:

Activity: Phone:
Country: Fax:
Web Site: Email:

LAMP SPECIFICATIONS*: *please refer to brochure “Technical description”

Voltage: ________V Power: _________W Filament Temperature: _________°Kelvin

Burning Position: Horizontal Universal

Lamp Type: DS DM DDS

DC DC DDSC
DB DL DDL
DA DT DDML
DL DDMS

Dimensions: Cables Terminal (If cables required):

OAL: mm Striped: Faston Male:
FL: mm Splice: Faston Female:
CL: mm Fork M5:
WL: mm Ring M4: Cable insulation sleeve: Yes No

Base Types: Base Types jacketed lamps:

B Jc T B
B splashproof Rs Gw Bj
Bf N Gs V
J Ns Magic Fit i Vj
Magic Fit id
Packaging: Standard Individual

USEFUL INFORMATIONS:

Application or system: ___________________________. Lamps annual consumption: Pcs

Voltage, dimming during operation: _____% to _____% Quantity per delivery: Pcs
Shock, vibration, acceleration: Yes No
Cooling system on sealing part: Yes No

COMMENTS:

DIRTECH – 32 RUE DE LA MENELLE 54540 PIERRE PERCEE FRANCE

Tel : +33 (0)3 29 42 60 96 – Fax : +33 (0)3 29 42 60 95 – email : info@dirtech.fr