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CT 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
Slice
1
2
4
6-8
16
32
64
128
Slice Time:
Generator:
Model:
kW:
mA:
kV:
Computer:
Model:
DOM:
SW Rev:
Archiving
MOD
DAT
CD
PACS
Other:
Application Platform:
WorkStation1:
Rev:
WorkStation2:
Rev:
Satellite Console:
Gantry Model:
Detector Type:
Slice Count
Scan Seconds:
as of:
Tube Model:
DOM:
MHU:
Air
Oil
Water
Slice Count:
Scan Seconds:
as of:
Tube Install Date:
Housing Type:
Permanatly Installed Software Options:
3D
Option:
Angiography
Option:
Bolus
Option:
Bone Mineral
Option:
Calcium Score
Option:
Cardiac
Option:
CT Flouoro
Option:
Dental
Option:
DICOM
Option:
Dose Modulation
Option:
ECG
Option:
Fusion
Option:
MIP
Option:
MPR
Option:
Neurology
Option:
Pediatric Protocol
Option:
Perfusion
Option:
Pulmonary
Option:
Virtual 4D
Option:
Virtual Colonoscopy
Option:
VRT
Option:
Radiation Protection Type:
Included
Chiller System:
Included
UPS:
Included
Power Regulation Device:
Included
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:
