Request Form “what I want”

＊＊ English only ＊＊

 











 Company/Hospital Name (Must)

 

 Your Name (Must)

Mr.Ms. 

 Family Name (Must)  

 First Name (Must)  

 Email (Must)

 

 TEL/Mobile (Must)

 

 Country/Shipping Destination (Must)

 

 ***** I am looking for this system! *****

 Product (Must)

CTMRIPET/CTSPECT/CTLinacCath-lab/AngioC-armX-ray (Rad-room)Others 

 Model

 

 By when/time duration

 

 Any comment