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 19662
Name Video Gastroscope
Brand FUJIFILM
Model EG-580NW2
Endorsement number
Status Under Nego
Price
Comment EG-580NW2 Gastrscope
Specification & Options *Insertion tube 5.9mm *Channel size 2.4mm *Working length 1100mm
Configuration
Condition Tested / Patient ready
inquiry*
(1000characters)