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Request form

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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 18821
Name X-ray
Brand SIMADZU
Model X’sy Pro
Endorsement number 220ABBZX00103000
Status Sold
Price
Comment General Radiographic System
Specification & Options *YOM2017
Configuration *Whole unit.
Condition Patient ready
inquiry*
(1000characters)