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	21124
Name	Gastroscope
Brand	FUJIFILM
Model	EG-6600R
Endorsement number	230AABZX00030000
Status	New Arrival Under Nego
Price
Comment	work with EP-6000 processor
Specification & Options	Insertion tube: 9.3mm Channel size: 2.8mm Working length: 1100mm
Configuration	-EP-6000 -EG-6600R -Keyboard
Condition	Patient ready
inquiry*	(1000characters)