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	18837
Name	Video Gastroscope
Brand	Fujifilm
Model	EG-L580NW7
Endorsement number	228AABZX00072000
Status	Sold
Price
Comment
Specification & Options	Insertion tube : 5.9mm Working length : 1,100mm *Channel size : 2.4mm
Configuration
Condition	Patient ready
inquiry*	(1000characters)