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	18547
Name	X-ray
Brand	SIMADZU
Model	X’sy
Endorsement number
Status	Sold
Price
Comment	Floor to Ceiling tube stand.
Specification & Options
Configuration	Generator type: UD150L-40E Tube Model: 0.6/1.2P38DE-85
Condition	Patient ready
inquiry*	(1000characters)