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C-ARM Form:
Printable Version
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
Hours on System:
Generator
Model:
kW:
mA:
kV:
Fluoro Boost
Model:
mA:
kV:
Computer
Model
DOM:
SW Rev:
Archiving
CD
DICOM
MATRIX
Other:
Image Storage Capacity:
Last Image Hold
Application Platform
Tube Model:
DOM:
MHU:
Image Intensifier Model:
Size of II:
DOM:
Number of Monitors:
Type:
Line Rate:
Permanatly Installed Software Options:
Surgical
Option:
FPS:
Angiography
Option:
FPS:
Neurology
Option:
FPS:
Cardiac
Option:
FPS:
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.
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:
