Request

Request form

Complete this form.

Company Name*
Your Name*
E-mail Address*
E-mail Address(Retype)*
Zip Code	( ex：999-9999 )
Country
Address1*
Address2
Telephone*	( ex：03-9999-9999 )
Fax	( ex：03-9999-9999 )
Mobile phone
Code	18235
Name	Electrosurgical Unit
Brand	Valleylab
Model	Force Triad
Endorsement number
Status	Recommend Sold
Price
Comment
Specification & Options	Dimensions and Weight Height: 25.5 cm Width: 45.8 cm Depth: 50.8 cm Weight: 15kg
Configuration	Main Unit
Condition	Tested to power on and all buttons working.
inquiry*	(1000characters)