Quote Request Form

Please fill in the required fields in the form below and click the SEND button.
※Fields marked [*] are required fields.

We may use the information provided by the customer to notify the customer about improved services and our products, primarily new products.
Please send the form after agreeing to notifications.

Company name *			※For individuals, please fill in your name.
Department, etc. *
Name *
Position
Industry *
Occupation *
Country *
Address *
Phone *			(e.g.:045-1111-1111)
Fax			(e.g.:045-1111-1111)
E-mail *
Confirm email address *

Model/Quantity *
Model			Quantity
Model			Quantity
Model			Quantity
Model			Quantity
Model			Quantity
Preferred Delivery Timing *
Urgent	1-2 weeks	Within 3 months	Other (Please indicate in the Notes field.)
Quote Details/Purpose *
Sample purchase (Trial)	Mass production	Replacement	Considering switching from other manufacturer
Notes/Message
Please tell us if you have any message, etc. about preferred delivery timing or customization not mentioned above.

Once completed, please click the CONFIRM button.