CUSTOM SPECIFICATIONS FORM
Company Name: 
Contact Name:
Address:
City/State/Zip:
Phone:
Fax: 
E-mail Address:

Please fill out below the items that pertain to your application
TYPE OF SCOPE
 Fiberscope
 Microborescope
 Videoscope
 Other

SHAFT TYPE
 Flexible
 Rigid

SHAFT FEATURE
 2-way articulating
 4-way articulating
 Non-articulating		 SHAFT SPECIFICATIONS:
Shaft Diameter:  
Shaft Length:     
Shaft Construction (braid, cover, other):  

OPTICAL SPECIFICATIONS:
Field of View:   
50 Degree (STD)      70 Degree (STD)
 Other :
Depth of View:  

EYEPIECE MAGNIFICATION:
 Standard
 Special:  
TYPE OF LIGHT GUIDE
End Fitting Type:  (Universal, ACMI, Wolf, Olympus or Chiu .625" Dia.) 
 Terminated (Connector on handle body)
 Continuous Length:  


Instrument Application:


Environment to be used in:


Accessories needed: