Your Name

Your Email Address

Facility Or Company Name

Phone Number

Fax Number

Trailer Information

Trailer Manufacturer

Date Of Manufacture

Length

Mileage

Number Of Popouts

Number Of Axles 2 3

Is the Trailer Shielded yes no

Size Of Generator

Type Of A/C Unit

Is The System On a Route Or Parked

Condition Of The Hydraulics

On a Scale Of 1 To 10, Rate The Cosmetic Condition 1 2 3 4 5 6 7 8 9 10  

M.R.I. Information

Manufacturer

Date Of Manufacture

Model

What is The Tesla Strength  

Type Of Magnet   

Type Of Shielding  

Number Of Consoles  1 2

Type Of Computer

What is The Software Level

Is There a 3D Workstation Yes No What Model

Diagnostic Packages i.e.  FSE, MRA

Does The System Have Phased Array No Yes

Coils Included

Type Of Storage Device

Is There A Imager Included Yes No   Model

When Is The System Available For Removal

When do You Need An Offer By

Who Is Servicing The System

On A Scale Of 1 To 10, Please Rate The Cosmetic Condition 1 2 3 4 5 6 7 8 9 10

Do Any Walls Have To be Removed To Get The System De-installed No Yes

Is There A Loading Dock At Your Facility Yes No

Asking Price

Any Additional Comments