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	17265
Name	CT
Brand	CANON
Model	Asteion S4
Endorsement number	21100BZZ00359000
Status	Sold
Price
Comment	4 Slice CT
Specification & Options	*TSX-021B
Configuration	Gantry Patient Bed *Generator
Condition	Excellent condition
inquiry*	(1000characters)