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 (note) Planning to launch in Aug 2022. 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. 800 JPY per dish) 1) Details of your SSCW sample order (Sterilized package by 6 dishes) 1 set = 18 dishes (9,000 JPY +Tax) Your Order: S-SSCW1:SSCW-1 set(s) S-SSCW2:SSCW-2 set(s) S-SSCWA0:SSCW-A0 set(s) S-SSCW-M1:SSCW-Mix (1/2/A0)* set(s) * 6 dishes per each type of SSCW (note) We will send you the estimate including shipping fee. In case of domestic shipping, Yu-Packet by Japan Post costs 381 JPY 2) Shipping Address Zip Code: Address: **Contact Person: **Email: **Telephone No: ** if Contact Person is different from the above 8.Inquiry on SSCW: