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	19356
Name	Video Gastroscope
Brand	OLYMPUS
Model	GIF-H260
Endorsement number	21400BZZ00284000
Status	Under Nego
Price
Comment	HDTV compatible
Specification & Options	insertion tube 9.5mm channel size 2.8mm working length 1030mm
Configuration
Condition	Patient ready
inquiry*	(1000characters)