Request Date:

Date & Time Required:

HOT Request

Company Name:

Contact Name:

Title:

Address:

City:

State:

Zip:

Phone:

Fax:

Email:

Distributor Name:

Distributor Phone:

SIMKAR/CEW Representative:

Project Name:

Application Type:

 Manufacturing
 Warehouse
 Retail
 Outdoor/Pole Mount

New or Retrofit:

 New
 Retrofit
 Replacement
One-For-One Only

Desired Light Level:

 FC
 Maintained
 Initial

Desired Lamp Type:

(HPS, MH, PS/MH)

Desired Lamp Wattage:

Length of Area (ft):

Width of Area (ft):

INDOOR:

Ceiling Deck Height:

Bottom of Fixture Height:

Work Plane Height:

Aisle Width (if applicable):

Rack Width (if applicable):

Rack Height (if applicable):

Environment:

 Clean
 Average
 Dirty

Ceiling Color:

(defaults to 50% reflectance)

Wall Color:

(defaults to 30% reflectance)

Floor Color:

(defaults to 20% reflectance)

OUTDOOR:

Pole Height:

Pole Width (Existing):

Shape (Existing):

Material (Existing):

List any local codes or restrictions:
(uniformity, light spill, etc.)