home /  Request form

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 19083
Name B/W System
Brand GE
Model LOGIQ 200MD PRO
Endorsement number 2110BZY00548000
Status Sold
Price
Comment BW system
Specification & Options
Configuration Microconvex BW Printer
Condition Patient ready
inquiry*
(1000characters)