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	19490
Name	Video Colonoscope
Brand	FUJIFILM
Model	EC-3000MP
Endorsement number
Status
Price
Comment	*Work with 3200/3000/4450 series Processor
Specification & Options	Insertion tube 12.3mm Channel size 3.2mm *Working length 1330mm
Configuration
Condition	-Patient ready
inquiry*	(1000characters)