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	19324
Name	Video Colonoscope
Brand	FUJIFILM
Model	EC-250WM
Endorsement number
Status	New Arrival Sold
Price
Comment	Work with EPX-201/202/203/2200 processor
Specification & Options	Insertion 12.8mm Channel 3.8mm Working Length 1330mm
Configuration
Condition
inquiry*	(1000characters)