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	20620
Name	Endoscopy System
Brand	OLYMPUS
Model	CV-170 Optera
Endorsement number
Status	New Arrival Under Nego
Price
Comment
Specification & Options	Dimensions:　295（W）×145（H）×425（D）mm Weight: 11.0kg
Configuration	CV-170 GIF-XP170N GIF-140 Pigtail Keyboard Cables *Water bottle
Condition	Patient ready
inquiry*	(1000characters)