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["温州市人民医院市场调研表"]
[]
["项目名称"]
["产地品牌",null,null,"型号规格"]
["生产厂家",null,null,"联系电话"]
["供应商",null,null,"联系电话"]
["资格审查             （自查）","医疗器械经营许可证（  ）",null,"报价单（  ）",null,"营业执照（  ）"]
[null,"产品注册证（  ）",null,"授权书（  ）",null,"销售记录（  ）"]
["销售记录","1.医院名称                                   成交价格："]
[null,"2.医院名称                                   成交价格："]
[null,"3.医院名称                                   成交价格："]
["报价方式","面谈□                电话□                 其他□"]
["专用耗材/易损件情况       （设备如需专用耗材请列明，未列明者视为永久赠送）","耗材1：",null,"报价：",null,"优惠价："]
[null,"耗材2：",null,"报价：",null,"优惠价："]
[null,"耗材3：",null,"报价：",null,"优惠价："]
[null,"易损件1：",null,"报价：",null,"优惠价："]
[null,"易损件2：",null,"报价：",null,"优惠价："]
[null,"易损件3：",null,"报价：",null,"优惠价："]
["供应商确认","拟销售价格：",null,null,"免费保修期："]
[null,"最终销售价格：",null,null,"免费保修期："]
[null,"能否提供备用机：能□   否□ ",null,null,"续保价格："]
[null,"其他：以上报价有效期为     个月"]
[]
[null,"签字确认：                          20   年     月     日"]

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