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	18941
Name	Endoscopy System
Brand	PENTAX
Model	EPK-i7000
Endorsement number
Status
Price
Comment	HD image processor & lightsource combo.
Specification & Options	* i-scan Enhanced Visualization Dims: 400 x 205 x 520mm Weight: 22kg
Configuration	EPK-i7000 Keyboard *NDS medical grade monitor Trolley not included in this offer.
Condition	Patient ready
inquiry*	(1000characters)