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I would like to
purchase
a system with the following specifications or...
I would like to
sell
a system with the following specifications.
Manufacturer
Model
Production Year
S/N
SiteID
Available Date
SW Rev
Current Settings
50Hz
60Hz
Generator
Model:
kW:
mA:
kV:
Single Phase
Three Phase
High Frequency
Yes
No
Table
Model:
Tilt Capable
Tilt
90/15
90/30
90/45
90/90
Image Intensifier
Model:
Size of II:
DOM:
Overhead Tube Crane
Model:
Tomo
No
Yes
Model:
Monitor
Cart
Suspended
Accessories:
Arm Boards
Infusion Bottle Holder
Leg Supports
Endoscopy Shelf
Camera
No
Yes
Type:
Table Top Extension
Workstation
Type:
Accessory Cart
Other Equipment
All System software and service codes must be on site and provided at time of removal.
All system manuals (operator and technical) must be on site and provided at the time of removal.
All service records must be on site and provided at the time of removal.
All phantoms must be on site and provided at the time of removal.
This installation is:
fixed
mobile
System is:
owned by facility
financed (owned by finance company/bank)
System Details
System is in good working condition and not in need of repair?
System is under service contract
No
Yes
with:
Location in facility (room number)
on floor
Loading dock is available?
System being replaced by:
Notes:
Site Info
Company/Entity:
*
Name/Rep:
*
*
Email:
*
Phone:
Deal Status:
Address:
Address (cont.)
City:
State:
Province:
Country:
Zip Code:
