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*Mandatory fields
Please check once before sending.

Salutation
First name*(半角英数30文字以内)
Last name*(半角英数30文字以内)
Occupation*
Age
Address*
Zip(半角英数30文字以内)
State/Province(半角英数50文字以内)
City*(半角英数50文字以内)
Street*(半角英数50文字以内)
Building name(半角英数50文字以内)
Country*(半角英数30文字以内)
Affiliation (name of dental clinic, dental laboratory, company, and educational institution, etc.)(50文字以内)
Phone(半角英数30文字以内)
E-Mail*(半角125文字以内)
(確認用)
Your message*(500文字以内)
Handling of personal information*

We will properly manage the personal information we receive and use it for market research / customer trend analysis, provision of product and seminar information, response to various inquiries, and business incidental to the above purposes. For more information regarding our handling of personal information, please refer to our privacy policy linked below.

Handling of personal information ▸

You can purchase our products through our distributor.
Please note that we do not sell directly.
Medical equipment and materials cannot be sold to anyone other than dental professionals.

This website uses SSL, an encrypted communication protocol, in order to securely send and receive personal information.