For more details and information about the CCD Upgrade please complete the form below. You must enter information in the boxes with BLUE titles to submit the form.
The personal details that we use to provide or promote our products and services (for example your name and telephone number), will NOT be passed to ANY organisation beyond Horiba Group, its Subsidiary or Associate Companies, Agents or Distributors to be used for marketing purposes.
Your Contact Details
Last Name
First Name
Title
Organization
Dept
Address
State/Province
Postal Code
Country(USA please include Zip)
Telephone
E-Mail
Fax
Please keep me informed with up to date information.
Your Interest
My interest is:
Information only
I intend to purchase
Now!
Possible purchase
Within 3 months
I have funding
Within 6 months
I am applying for funds
Within 12 months
Salesperson please call
More than 12 months
CCD Information:
CCD Controller:
CCD-2000
CCD-3000
CCD Serial Number:
CCD Type:
512 x 512
2000 x 800
1024 x 128
2048 x 512
1024 x 256
Comments
Please include any comments or further information about your requirement below:
