Inquiry Form: SSCW Smart Surface Culture Ware * Required to enter 1.Name * First Name Family Name Middle Name 2. Affiliation * Name of University / Institution 3. Department * Faculty & Laboratory / Department 4. Job Title * 5.E-mail Address * 6.Telephone No. * 7.SSCW sample/product request: a. Type of cells (CSTERM may provide specific culture advice) 1) 2) 3) b. Do you request AMAZON BUSINESS info when we start to sell SSCW ? Yes c. Do you purchase SSCW sample now ? (500 JPY per 3.5cm dish) Yes (Note) SSCW price list will be informed before its launch (approx. JPY 800-1,000 per dish) 1) Details of your SSCW sample order (Sterilized package by 6 dishes) 1 set = 18 dishes (9,000 JPY +Tax) Your Order: SSCW-S (Standard) 18 dishes JPY 9,000 set(s) SSCW-L (More adhesive) 18 dishes JPY 9,000 set(s) SSCW-Mix (S/L:12 dishes per each) JPY12,000 set(s) SSCW-OX: Semi-order 18 dishes JPY12,000 set(s) Semi-Order No informaed by CSTERM: (Note) We will send you the estimate including shipping fee. In case of domestic shipping, Yu-Packet by Japan Post Service costs 381 JPY up to two packs 2) Shipping Address Zip Code: Address: **Contact Person: **Email: **Telephone No: ** if Contact Person is different from the above 8.Inquiry on SSCW: