Home /  Request form

Make a request

Request form

Complete this form.

Company Name*
Your Name*
E-mail Address*
E-mail Address(Retype)*
Country
Zip Code ( ex:999-9999 )
Address1*
Address2
Telephone* ( ex:03-9999-9999 )
Fax ( ex:03-9999-9999 )
Mobile phone
Code 15080
Name Video Gastroscope
Brand FUJIFILM
Model EG-L590ZW
Status Recomment
Comment
Specification & Options *Insertion Tube 9.8mm *Channel Size 2.8mm *Working Length 1,100mm
Configuration *Case and Valves
Condition
Inquiry*
(1000characters)