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	18400
Name	CT Scanner
Brand	CANON
Model	Alexion 16
Endorsement number
Status	Recommend Sold
Price
Comment	*Alexion 16 TSX-032A/2R
Specification & Options	YOM: 2015 Software Version: V6.0 Loaded with all options CXB 200F Tube Tube installed 2015/Jan (never changed) Exp Count: 112,617
Configuration
Condition	Patient ready
inquiry*	(1000characters)