1) Company

Company Name*
address *
telephone * - -
FAX* - -

2) Terms desired for optical uses

Field of View (V)x (H)mm
Min, Working Distance mm
Camers Format 1/4"   1/3"   1/2"   2/3"   1"
Exception, the detailed is needed for Line CCD Cameras (2K, 4K, 8K, 12K, etc)
Camera Mount C-mount F-mount etc
Illumination Method Coaxial Illumination
etc Other (Ex. ring illumination, backlight, dome, etc.) brief description of illumination conditions
Resolution of N. A. aprox. or
Depth of Fielt aprox. (㎛ or mm)
Optical Distortion % below
Adjustment method of optical ratio fixed scale   Zoom
Requirement for optical system (a) Size : length mm
(b) Width (diameter) mm
(c) Weight g
Brief description
of the measured object
Estimate cost and quantity needed Estimate quantity