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	14578
Name	CR System
Brand	FUJIFILM
Model	FCR CAPSULA 2
Endorsement number
Status	Recommend Sold
Price
Comment
Specification & Options	*YOM
Configuration	CR Workstation Capsura 2 Image Reader *4 Cassette 10x12, 14x14, 14x17
Condition
inquiry*	(1000characters)