*Indicates Required Fields
Company Name*
Contact Person*

Phone*
 Fax
Email Address*

P.O. Number

Date

Catalog Number*

Lamp Required*

Type of Photometric Test Requested
 Indoor Roadway Floodlight
  VCP Table (additional cost)
Yes No

  Isofootcandle Plot (additional cost)
Yes No       Mounting Height 

  Quick Select Table (additional cost)
Yes No

  Circle of Light (additional cost)
Yes No

Mounting Height (If Roadway Test)
Disposition of Luminaire After Testing

Our standard method of shipping is UPS ground. If you prefer an alternate method of shipping please indicate your preference in the Special Instructions area.

 
 

Return (3 weeks after testing is complete)

Return immediately after testing

Scrap

Hold for further testing
Special Instructions


Luminaire Testing Laboratory, Inc.
905 Harrison Street Allentown, PA 18103
Ph (610) 770-1044 * Fax (610) 770-8912
 

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