STEP 8 Add Logo (Additional charges apply) ■ No Logo Logo is left chest placement only. See page 2 for placement diagram.

■ Customer Logo – Please send JPEG artwork with this form to orders@coneinstruments.com ■ Vendor Stock Design – View options at www.shieldingintl.com/embroidery ■ Medtronic Logo (Model #CCN17515)

Apron Options & Sizing Order Form

STEP 3 Choose Protection Option RL = Regular Lead TL, TLL = Lite Ply 15–20% Less Weight ($ Additional charges apply.)

■RL (0.5mm LE) ■TL (0.5mm LE) ■TLL (0.35mm LE)

STEP 4 Choose Apron Fabric and Color Please Enter 2-3-Digit Code from page 3

STEP 5 Choose Belt Size – Back Relief (BR Model only) Size: ■Small, 28"-38" ■Medium, 36"-48" ■Large, 44"-58"

STEP 7 Choose Apron Embroidery – Model #5086107 ($ Additional charges apply). Embroidery is left chest placement only. Block Style. Up to 20 characters per line, 2 lines Maximum. Please note: Embroidery is case sensitive and will be created exactly as written on lines below.

Choose Embroidery Color – ■ Black ■ White __________________________________________________________________

__________________________________________________________________

STEP 1 Choose Model (ex: Standard Coat with Ties =ST)

STEP 2 Measure and place sizes into chart

CA

LL

: 80

0.32

1.69

64 /

FAX

: 80

0.98

7.C

ON

E

C

LIC

K:

CO

NE

INS

TR

UM

EN

TS

.CO

M

EM

AIL

: O

RD

ER

S@

CO

NE

INS

TR

UM

EN

TS

.CO

Mconeinstruments

Your First Call for Medical Imaging Supplies

Frontal ApronST, SV, SQR, AF, AFQR, BR, FB,SDO, FW, TQW, TQWQR

Chest

LengthRecommended

length: top of knee

From sternal notch to desired length

Attention: Aprons are made to order and are non-returnable/non-refundable. Please be sure measurements are accurate.

Sizing Your Frontal ApronLengths are measured from the sternal notch to the bottom hem (recommended apron length: top of knees)

Chest Widths are measured side-to-side at a point just below the armholes Size Charts available online

Available Models

ST ......Standard Coat with TiesSV......Standard Coat with VelcroSQR ..Standard Coat with Quick Release Buckle

AF.............Adjust-A-Fit with VelcroAFQR .......Adjust-A-Fit with Quick Release BuckleBR ............Back Relief with VelcroFB.............Flex Back with VelcroSDO .........Surgical Drop Off with VelcroFW ............Fast Wrap with VelcroTQW .........Three-Quarter Wrap with VelcroTQWQR ...Three-Quarter Wrap with Quick Release Buckle

1

Frontal Apron

Chest

Length

AF, AFQR

SDO

BR

FW

FB

TQW, TQWQR

ST, SV, SQR

STEP 9 Add Optional Thyroid Collar and Tether ($ Additional charges apply.) Collar Options Add Tether* Choose Thyroid Collar Fabric and Color

■ Small Comfort Fit Thyroid Collar #5086193 ■Please Enter 2-3-Digit Code from page 3 ■ Large Comfort Fit Thyroid Collar #5086194 ■

*Collar tethered to apron on right side by a ring for easy removal

See page 2 for placement diagram

Contact Name: Date: Email: Phone: Ship to Address:

STEP 6 Patch Pocket (Model #45576) – ■Yes ■No (Left chest placement only) ($ Additional charges apply).

Length* Height32" 5'3"-5'5"34" 5'5"-5'8"36" 5'8"-5'11"38" 5'11"-6'2"

*Charged by inch for added length or width. Measure from sternal notch to 1"

above knee

STEP 10 Please indicate “L” for Logo, and/or “E” for Embroidery Placement Below:

STEP 11 Please indicate “L” for Logo, and/or “E” for Embroidery Placement Below:

CA

LL

: 80

0.32

1.69

64 /

FAX

: 80

0.98

7.C

ON

E

C

LIC

K:

CO

NE

INS

TR

UM

EN

TS

.CO

M

EM

AIL

: O

RD

ER

S@

CO

NE

INS

TR

UM

EN

TS

.CO

M Apron Personalization (optional) ($ Additional charges apply.)

Thyroid Collar Personalization (optional) ($ Additional charges apply.)

Left ChestOnly

Logo Placement = LEmbroidery Placement = E

Logo Placement = LEmbroidery Placement = E

Apron Options & Sizing Order Formconeinstruments

Your First Call for Medical Imaging Supplies

Front Bib

Left StrapRight Strap

2

Choose Thyroid Collar Embroidery* – ■Black ■White

________________________________________________

________________________________________________*16 characters maximum on Right and Left Sides OnlyFor small Comfort Fit Thyroid collar (#5086103) cannot be embroidered on the left strap. Right and front side only.

Contact Name: Date: Email: Phone: Ship to Address:

Nylon

FABRICS & COLORSconeinstruments

Your First Call for Medical Imaging Supplies

CA

LL

: 80

0.32

1.69

64 /

FAX

: 80

0.98

7.C

ON

E

C

LIC

K:

CO

NE

INS

TR

UM

EN

TS

.CO

M

EM

AIL

: O

RD

ER

S@

CO

NE

INS

TR

UM

EN

TS

.CO

M

3

Designer Fabric

Diamond Ripstop

BermudaBM

ButterfliesBUT

Pink CamoPC

Faux LeopardFAL

Orange FloralOF

Green SurfGF

Royal PawsRY

ZebraZB

Red FlamesRF

Chocolate FloralCFL

Hearts of ColorHC

Storm CamoSTC

Wild Cat PinkWC

Flower PowerFP

Tiki BlueTB

Dog PawsDW

Blue SquaresBSQ

Red PlaidRI

Royal PlaidROP

Gray SquaresGS

StarsTS

Green PlaidGL

SplatterSR

DenimDM

Blue PlaidBPL

White Lil’ CherriesWLC

Hot Pink PlaidHO

Desert CamoDO

AquaAQ

MaroonMN

Orange18

Light OrangeLIO

Forest GreenFO

NavyNV

PinkPK

CharcoalCC

TealTL

PurplePL

RedRD

Light BlueLB

Lime GreenLM

True RoyalTU

Hot PinkHP

SilverSI

YellowYL

TanTN

Royal BlueRL

MauveMV

CoffeeCOF

BlackBK

Black Diamond

BA

Kelly Green Diamond

KG

Red Diamond

RM

Fuschia Diamond

FD

Marine Blue Diamond

MBD

Silver Diamond

SVD

Cinnamon Diamond

CD

Lavender Diamond

LD

Royal Blue Diamond

RO

Charcoal Diamond

GM

Purple Diamond

PD

Slate Blue Diamond

SBD

Tan Diamond

TAD

Brown Diamond

BRD