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Customer information input form

Please complete the following information for our use in notifying you with product updates, changes and revisions in product applications and related information. Your contact information will be kept confidential and will not be released for use other than by Meni-One. Your input and questions are very important to us, and we will do our best to respond promptly.
* a required entry item
Company or hospital name
Animal medical personnel *
Yes No
Name *
Country *
E-mail *
(for confirmation) *

Handling of personal information

Regarding how your personal information will be handled, please see the description in the “Privacy policy.” If you agree, please check “I agree” before confirming your entries.
I agree.
We will reply to you within one week after receiving your inquiry. If you do not receive our response, please contact us again. Also, please check whether our reply email was placed into your “spam folder.”