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	20212
Name	Ventilator
Brand	Drager
Model	Savina 300
Endorsement number
Status	New Arrival Under Nego
Price
Comment
Specification & Options	Dims: W460 x H383 x D364 without trolley Weight: approx. 26 kg without trolley
Configuration	Provided with what pictured only.
Condition	Patient ready
inquiry*	(1000characters)