Product Request Form - Medical Light Guides

Information you submit on the form below will be sent to Fiberoptic Components. If you wish to also send us drawings, they can be sent via email ( sales@lightguides.com ) or fax ( 978-422-0050 ). Please note your company and contact name on the drawings.

Click the link below for a printer friendly version of the form if you would rather fill out the form offline and mail or fax it Fiberoptic Components.

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data sheet and request form [PDF format]

Company Name*
Contact Name*
Title
Address
City, State & Zip/Postal Code
Email*
Phone*
Fax
Web Site

Fiber

	NA
	.55	.66
Borosilicate (Glass)
	3.5mm	5.0mm	Other
Bundle Diameter

Sheathing

Silicone		Color
Crush Resistant Silicone		Cable Length
Other

Tip Configuration

Quantities & Other Specs

Operating Temperature Range
Qty Range 1
Qty Range 2
Qty Range 3
Description (email or fax drawing separately if applicable; see our product pages for drawings)
Other Notes

Email Address: