C Arm Data Sheet
Your Name
Your Email Address
Facility Or Company Name
Phone Number
Fax Number
Manufacturer
Date Of Manufacture
Model
Number Of Monitors 1 2
Age And Size Of The Image Intensifier
Type Of Storage
Does The System Have Digital Subtraction
List The Diagnostic Packages
Are There Any Other Accessories
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
When Is The System Available For Removal
When Do You Need An Offer By
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 Or Accessories