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	19764
Name	DR System
Brand	KONICA MINOLTA
Model	AERO DR
Endorsement number	225ABBZX00011000
Status	New Arrival Under Nego
Price
Comment	*Flat Panel Detector
Specification & Options
Configuration	14x17 detector PC Console CS-7 *Monitor
Condition	Patient ready
inquiry*	(1000characters)