| Custom RFQ Form: |
| Contact Name * |
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| Company * |
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| Job Title |
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| Email Address * |
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| Phone Number * |
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| Address 1 |
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| Address 2 |
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| City |
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| State |
Zip |
| Country |
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| Fax |
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| Application: | Optical System |
| | Machine Vision |
| | Single Window/Lens |
| | Assembly |
| Design Transmission Wavelength: | |
| Preferred Substrate Material: | (float glass, Crown Glass,
Borosilicate, Sapphie, Zinc Sulfide, Zinc Selenide, etc.) |
| Dimensions |
| Outside Diameter: | Tol. ± |
| OR Width: | Tol. ± |
| X Height: | Tol. ± |
| Thickness: | Tol. ± |
| Anti-Reflection Coating Required: | Opposite Surface Pattern Surface |
| Angle of Incidence: | |
| Other Details: | |
| How is the reticle viewed? | Transmission
Reflection Edge-Lit |
| Pattern (if available) | Upload a file from your computer (.dwg, .dxf, .pdf, .jpg, other):
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| Minimum feature dimensions: | Tol. ± |
| Positional Accuracy: | Tol. ± |
| Overall Accuracy: | Tol. ± |
| | You may also fax a sketch to 215-842-3637 |
| Environmental Conditions: | Lab Conditions
Space / Vacuum |
| Operating Temperatures: | Min: Max: |
| Humidity Conditions: | |
| Other Considerations/Concerns: | |
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