NAFA Medical
Inquiry Form

* First Name: * MI: * Last Name:
* Title:     * Company:
* Email:     * P.O. Box:
* Zip Code:      * Tel:
* City:     * Fax:
Address:        
         
      Did the customer deal with NAFA Medical before? Yes No
         
      Goods Customer are interested in are:  
  1   Critical Care Products
  2   Orthopedic Products
  3   Pharmaceutical Products
  4   Herbal Products
  5   Laboratory & Disposable Products
  6   Renal Products
  7   Medical Equipment
  8   Government Tender

Comments or Questions:

   

    

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