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	20333
Name	CT
Brand	CANON
Model	Aquilion Prime
Endorsement number
Status	New Arrival Recommend Under Nego
Price
Comment	160 Slice CT Scanner
Specification & Options	TSX-303A YOM2017 Software Version - V8.2. Cardiac included. Tube(CXB-750D) Exp. count - 112,615 Last tube change - January 27, 2021. ECG, Injector, Phantom, software CD included.
Configuration
Condition	Patient ready
inquiry*	(1000characters)