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	18798
Name	X-ray
Brand	SIMADZU
Model	X’sy Pro
Endorsement number	220ABBZX00103000
Status
Price
Comment	General Radiographic System
Specification & Options	*YOM2019
Configuration	Whole unit. 200mA-250mA.
Condition	Patient ready
inquiry*	(1000characters)