Custom Order Product Inquiry

If you wish to make an inquiry regarding custom ordered products, please fill out the necessary information in the form below and send it to us. A representative will respond to your request.

We require that you fill in items marked with an asterisk (*).

Please rest assured that in no case will we ever individually disclose any private information that we receive to external parties. For more details, please refer to our company's "Privacy Policy."

Intended use for Light Units, UV irradiators, or Light Sources*
Please provide us with your inquiry for custom order products. A representative will respond to your request on a later date.*
Please provide us with information on your inspection object, puropose, and other required details.*
Attach Materials/Documents
If you have any supplementary materials or documents relevant to this request, please attach them.

If you wish to specify a delivery address that is different from the address you provided during membership registration, please provide it below. We require that you fill in items marked with an asterisk ().

We require that you fill in items marked with an asterisk (*).

Company / Organization*

Please enter your official company name and office name.

Name of Sales Office/Branch/Business Location
Section / Department*

Please enter your official department name.

Title
Name*
Address Zip / Postal Code*
Country*
Address*
City*
State
Phone*
Fax
E-mail*

Please provide us with your company's current status in relation to the purchase and implementation of lighting/light irradiation fixtures/light sources.

Q1. When do you plan on purchasing/implementing new Light Units, UV irradiators, or Light Sources?*
Q2. What is your purpose for purchasing/implementing Light Units, UV irradiators, or Light Sources?*
Q3. If there are existing products that you are currently making use of, please let us know what they are.

Manufacturer Name

Model Name

Number of Units Installed