Estimate Request Sheet


1. MY HID FIXTURES ARE FROM 1980 OR NEWER:

      yes

      no

2. MY HID FIXTURES HAVE DISCRETE COMPONTENTS ("DISCRETE" = NOT FILLED WITH POTTING COMPOUND):

      yes

      no

      both

3. DISCRETE COMPONENT HID FIXTURES -- Check the type of fixtures you have:
                      I have Metal Halide:
                      I have High Pressure Sodium:
                      I have Mercury Vapor:
                      I am not sure:

4. DISCRETE COMPONENT HID FIXTURES -- FILL IN QUANTITIES BY WATTAGE:

       175 Watt:                         250 Watt:

       320 Watt:                         400 Watt:

     1000 Watt:                       1500 Watt:

Other wattage:                  Other wattage:

5. I CAN EMAIL PICTURES OF EACH FIXTURE TYPE TO: info@wiballast.com

      yes

      no

6. DO YOU HAVE ANY FLUORESCENT BALLAST OR LAMPS TO RECYCLE?

      yes

      no

    IF YES, PLEASE LET US KNOW BELOW WHAT YOU HAVE, i.e. We
    have 120-4'x 2 lamp fixtures with non-pcb ballast or 50-8'x2 lamp
    HO fixtures with PCB Ballast.

7. JOB LOCATION:
Job location Zip Code:

8. MY CONTACT INFORMATION:
First Name:  
Last Name:  
Company Name:  
Address:  
City:      State: 
Zip Code:  
Email Address:  
Daytime Phone Number:  ()-
Fax Number:  ()-


9. FORM SECURITY CHECK:
                                              
Enter characters from the image:


10. IMPORTANT: When finished filling in this form, remember to push the "Send Form" button below to e-mail your information to us. We will provide a prompt and complete estimate for your review.


If you have any questions or need further clarification regarding this form, you can either email us at info@wiballast.com or call us at 800.345.HIDS (4437).

We look forward to helping you with your
non-PCB & regulated ballast and lamp recycling needs!