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	19051
Name	Color Doppler
Brand	HITACHI
Model	Hi Vision Preirus
Endorsement number
Status	Sold
Price
Comment	General/OB/GYN/cardiac/vascular/small parts application
Specification & Options	Options Enabled: CW doppler Elastography
Configuration	Convex Linear *Sector
Condition	Patient ready
inquiry*	(1000characters)