Application RFQ

In order for us to serve you best complete the requested information below. Our staff will be glad to process your request for LED lighting and provide you with an obligation free quotation.

Select if the application is indoors or outdoors:
Indoor         Outdoor

Indicate which power sources your application will utilize:
Line Powered - Single Phase 90-220VAC 50-60Hz
12 VDC - Most automotive / battery applications / Solar
24 VDC - Industrial DC Power / Solar
Other - Please Specify

Provide a description of your LED Lighting Application:
Please try and indicate the following where applicable:

• Type of lighting required, i.e accent, ambient, task.
• Approximate size (length x width x height) of area to be illuminated.
• Does the application require hazardous location approval
• Special Mounting constraints
• Are there any specific challenges in this application? (i.e. High temperature)

Customer Information
Full Name:		Required
Company:
Email:		Required
Phone:		Required
Shipping Information
To assist us in making your quotation as accurate as possible provide a desired shipping address.
Address 1:		Required
Address 2:
City:		Required
Country:	AlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua & BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanAzoresBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBoliviaBonaireBosniaBotswanaBrazilBritish Virgin IslesBruneiBulgariaBurkinaBurundiCambodiaCameroonCanadaCanary IslandsCape VerdeCayman IslandsCentral African RepChadChannel IslandsChileColombiaCook IslandsCosta RicaCote d' IvoireCroatiaCubaCuracaoCyprusCzech RepublicDem Rep of CongoDenmarkDjiboutiDominicaDominicanEcuadorEgyptEl SalvadorEnglandEquatorial GuineaEritreaEstoniaEthiopiaFaeroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHollandHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKosraeKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMadeiraMalawiMalaysiaMaldivesMaliMaltaMarshal IslandsMartiniqueMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontserratMoroccoMozambiqueMyanmarN. Mariana IslandsNamibiaNepalNetherland AntillesNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNorfolk IslandNorth KoreaNorthern IrelandNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeoples Rep of ChinaPeruPhilippinesPolandPonapePortugalPuerto RicoQatarRepublic of CongoRepublic of IrelandRepublic of YemenReunionRomaniaRotaRussiaRwandaSabaSaipanSan MarinoSaudi ArabiaScotlandSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSouth AfricaSouth KoreaSpainSri LankaSt. BarthelemySt. ChristopherSt. CroixSt. EustatiusSt. JohnSt. Kitts & NevisSt. LuciaSt. MaartenSt. MartinSt. ThomasSt. Vincent/GrenadineSudanSurinameSwazilandSwedenSwitzerlandSyriaTahitiTaiwanTajikistanTanzaniaThailandTinianTogoTongaTortolaTrinidad TobagoTrukTunisiaTurkeyTurkmenistanTurks & Caicos IslesTuvaluUgandaUkraineUnion IslandUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Virgin IslandsUzbekistanVanuatuVatican City StateVenezuelaVietnamVirgin GordaWake IslandWalesWallis & Futana IsleWestern SamoaYapZambiaZimbabwe	Required
Province/State:	Outside U.S./CanadaAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland/LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMiconesiaMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming	Required
Postal/Zip Code:		Required
For our internal use regarding marketing and advertising please answer the information below.
Which market category does your LED Lighting application fall under:
Industrial     Commercial     Residential     Other
If "Other" was selected please specifiy
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