When you need a lens to your specification...

Print this page, complete the questionnaire and fax us your requirements today!

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.


        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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