System Resell / Trade Request
System Resell / Trade Request
Company Name
*
Requester Name
Requester Name
*
First
Last
Email
*
Phone
Phone
*
-
###
-
###
####
Best Form of Contact
*
Email
Phone
What is your specialty
*
Ambulatory
Equipment | Parts Dealer
Hospital
Imaging Center
Independent Service Provider
Oncology
Orthopedics
Pain Management
Physician Practice
University | College Medical Program
Other
Part Information
System Type
*
Bone Dense
C-Arm
Cath | Angio
CR
CT
Dexa
DR Panel
Imager
Lunac
Lithio
Mammo
MR
Nuclear
PACS
PET
PET|CT
SPECT|CT
Portable X-Ray
Rad Room
RF
Ultrasound
Other
System OEM
*
System Model & Series
*
Date of Manufacture
*
Is this system still in clinical use?
*
Yes
No
Is there a loading dock at the location where the system is?
*
Yes
No
Unknown
Which best describes the physical condition of the system?
The system has no deficiencies.
The system has slight cosmetic deficiencies.
The system has serious cosmetic deficiencies.
Are there any logistics we can assist with on this project?
Are there any logistics we can assist with on this project?
System Inspection
De-Installation
Re-Installation
Shipping
Rigging
Refurb | Recondition Quote (after inspection)
Storage
Shielding
Build out
Service Quote
Other
Please detail any usage on the system that would help determine value. i.e. Tube usage, scan seconds, cold head usage etc.
Which best describes the reason for this request.
Looking to sell equipment
Looking to trade equipment for an upgrade
still deciding
Other
Please describe any additional details about this project.