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100 East Glenside Avenue,
Glenside, PA. 19038 USA Tel: 1 (215) 517-8700 | Fax: 1 (215) 517-8747 | info@solarlight.com | www.solarlight.com
Date: ___________________ From: (Complete name and address) Person name: _______________________________ Company name: _____________________________ Street Address: ______________________________ City: ________________________ State: ______________ Postal code: ________ Country: _________________________ Telephone: ______________________ FAX No. _____________________________ E-Mail: ______________________________ Payment Information: Credit Card: MasterCard / Visa / Amex / Discover Credit Card #____________________________________ Exp. ________________ PO # _____________________________ Testing required: (Please check off the type of testing required) [ ] Accelerated UV testing of a material. [ ] Spectral light transmission characteristics of a material. [ ] Spectral response of a detector. [ ] Spectral output of a light source. Other (explain below): ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ List the items being sent in for testing: 1. Description:_______________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 2. Description:_______________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 3. Description:_______________________________________________________ ___________________________________________________________________ ___________________________________________________________________ 4. Description:_______________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Return Shipping Instruction: Ship to address: (Complete name and address) Check if same as above _______ Person name: _______________________________ Company name: _____________________________ Street Address: ______________________________ City: ____________________ State: _________________ Postal code: _________ Country: _________________________ Telephone: ______________________ FAX No. _____________________________ E- Mail: _________________________________________ COMMENTS: __________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ____________________________________________________________ ____________________________________________________________ |
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