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	19993
Name	Color Doppler
Brand	CANON
Model	SSA-660A Xario
Endorsement number
Status	New Arrival Sold
Price
Comment	Application Gereral OB/GYN Cardiac vascular
Specification & Options	Color Doppler PW/CW doppler Power doppler LCD monitor
Configuration	Convex PVT-375BT Linear PLT-703AT
Condition	*Recondition
inquiry*	(1000characters)