Information Request Form

Section:	Main.A2. TRADEMARK. INDEX. Fn-Fz.Fotivda (POK)
Code:	89324
Product:	USA. A
Company or Organization:
Contact's name *:
Position:
E-mail:
Mailing address:
Phone number:
Fax number:
Fields of interest:	INDICATION'S COMPANY LICENSEE PATENT NUMBER GENERIC NAME
* If you are not linked to any company or organization complete at least this field