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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:______
Please identify this form with the following:

Date:

Name:

Email:

P.O. Number: