IC Optical Systems

Information Request Form

Please note that you need only fill in the fields that are highlighted in bold.

Name

Telephone Number

Job Title

Fax Number

Company or Institution

e-mail

Address

Zip / Postal Code

Country

To help us identify your requirements please fill in the following information below

Do you already use any ICOS products?
YesNo

What is your area of interest?
Fabry-Perot Substrates
Etalons
Lenses
Flats
Prisms
Other Optics (please enter details in the additional comments field)

What is the nature of your requirement?
Research
Production Test
Small volume manufacture

When are you likely to implement your requirement?
Immediate
Six Months
Greater than Six Months (Long Term)

Where did you hear about us?
A friend or colleague
A web site, search engine, or newsgroup	Which one?
A trade show	Which one?
A trade journal	Which one?
Other	Please specify

Additional comments
Anything else that you consider important or you think we should know.
For example:
Do you require our current tool list to optimize your lens designs?
Do you have any specific wavelengths of interest? etc.

Thanks!

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