Custom Application Form

Fields marked by an asterisk * are required.
 

Customer Information

Name: *
Organization:
Title:
Address1:
Address2:
City, State, Zip: ,
Phone: *
Fax:
E-mail:
 

Application

 

Requirements

Mechanical

Type of Scope: Borescope (Rigid) Micro  Fiberscope  
Videoscope  Other 
Working Length:
WL Diameter:
Line of Sight:
Other:

Optical   (Not all should be filled in, just the one(s) of primary importance.)

Object Distance (OD):
to inches  mm
Smallest Object to Resolve:
at Object Distance inches  mm
Resolution Spec:
Field of View (FOV): Fixed °  or Variable (Zoom) °  to °
Mag Requirement: X  at      inches   mm Object Distance
Image Orientation:

1.gif
Normal Erect

2.gif
Reverted Erect

3.gif
Normal Inverted

4.gif
Reverted Inverted

Other:
 

Viewing Modes

Eyepiece
(visual mode):

Yes  No

Video
(video mode):

Yes  No     If Yes, complete the following

 
CCD Format: 1/4" 1/3" 2/3"  Other
Image Format: V      H    D      Other
   
Photo
(photo mode):
Yes  No   If Yes, Camera Make 
                   & Model 
Simultaneous Multi-mode Viewing:
Yes  No If Yes, What Modes? Visual 
Video   Photo
 

Environment

Special Requirements (high or low temperature or pressure, gaseous, chemical, radiation):

 

Lighting:

Standard White Light UV Other
 

Electrical:

115VAC/60Hz  230VAC/50Hz   Switchable  Other