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(* = required field)

1.Name * ex. Taro Nagaoka
2.Affiliation * ex. Nagaoka System Co., Ltd.
3.Address  
  Postal Code ex. 940-0001
  Address ex. Fukazawa , Nagaoka, Niigata, JAPAN
4.Tel * 例 0258-12-3456
5.E-mail address * 例 nagaoka@system.com
6.subject ex. about Y2O3/glass
7.Requirements   document request
  meeting
  quotation
  delivery date
  others
8.Comment