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	19942
Name	Electrosurgical Unit
Brand	Ellman
Model	サージトロンEMC
Endorsement number
Status	New Arrival
Price
Comment	-Sharp and fine incision power -Reliable, non-stick, hemostatic force -Can be used over the patient's clothing.
Specification & Options
Configuration	-You will get what pictured.
Condition	Patient ready
inquiry*	(1000characters)