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Form 3
Custom Combs,
UV-Transparent Trays
&
Radiation Shielded Boxes
Fax this form along with
Form 1 (Standard Equipment)

Koh Development will design and manufacture equipment
to your specifications. We will consult with you to be sure
the equipment meets your needs.

FAX: 321-821-1819
Phone: 321-872-0940

Radiation shielded Boxes
(1.27 cm. thick material)

D:_______ L:_______ H:______

Picket Fence Comb (PF)

Total number of teeth:______
A: Length ______
B: Width of tooth ______
C: Space between the teeth ______
D: Thickness: ______

         Shark Tooth Comb (ST)        

Total number of teeth:______
A: Length ______
B: Distance between the points______
     (Standard distance is 5.9mm)
C: Thickness ______

Please identify this form with the following:

Date:

Name:

Email:

P.O. Number: