YAMAGUCHI MICA CO., LTD.    
SAMPLE REQUEST

For requesting  Please fill in the information below and send to us.
Your information  (1) Company or organization
 (2) Department
 (3) Name
 (4) Address
 (5) TEL
 (6) Purpose
 (7) Item name, Qty
 (8) Others
E-mail / Fax  E-mail: sample@ymsc.co.jp / FAX: +81-533-72-5157
Please read
before requesting
--- The sample supply is for the purpose of evaluating the product to the customer,
  and does not guarantee the future supply. For adopting our product, please
  contact our sales dept.
--- There is a possibility that we might not be able to meet your needs.
--- We will manage the handling of your information properly.
--- If you do not have our return within a week, please contact again.

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