Name : Telephone :
Company : Facsimile :
Address : Mobile :
Email :
I am interested in the followings products.
Product Interested : RO-102     RO-103     RO-103TDS     AstroBoy     Office Dispensor
   Others, please specify : 
Please send me a price quotation   I would like to request for a free demonstration
Please arrange a demonstration for me at my home*   Please have your sales representative call me
I will like the demonstration performed at your office   There will be about participant(s) attending
The most appropriate day to conduct demonstration is on          at     AM PM
Demonstration Address ( if different from above address ) :