服務需求單

為了讓我們能夠提供您更好的服務，請填寫下列所有 * 欄位。

詢問類型 * 健檢服務教機服務
機器型號 *
機台序號 *
需求描述 *

請完整描述您本次的需求內容 Please tell us details about your needs here..
附件上傳 Upload a File (大小限制:10mb)

您可以上傳一個附件，例如圖檔。 If you have your request in a file, then you can simply upload a file to us directly.
公司名稱 Company Name *

請填寫完整的公司名稱 Please enter your company name here.
公司網站 Company Website

請輸入貴公司的網站URL Provide your company web site if you got one.
國家 Country *

請選擇您的國家 (預設為台灣) Select your company location here.
商業型態 Business Type *

請選擇您的商業型態 Please select what business type you are.
聯絡人 Contact Name * First Last
請留下您的大名 Please enter contact person's name.
電子郵件 E-mail *

Please enter valid email address here.
電話 TEL *

請留下您的聯絡電話或行動電話 Please enter correct phone number here.
傳真 FAX

如可以，請留下您的傳真號碼 Please enter correct Fax number here.
請輸入以下圖片中的辯證碼(其可能為英文與數字的組合)
Type the letters you see in the image below.
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By consenting to this privacy notice you are giving us permission to process your personal data specifically for the purposes identified. Consent is required for us to process your personal data, and your data will not be shared to third parties.