Your Name

Your Email Address

Facility Or Company Name

Phone Number

Fax Number

Manufacturer

Date Of Manufacture

Number Of Detectors 1 2 3  

Is The Detector(s) Variable Angle Or Fixed

Age And Condition Of The Crystal

Number Of PMT's

Is The System SPECT Yes No

Does It Do Whole Body Yes No

Studies Performed

Computer And Software Level

Diagnostic Packages i.e. 3D, Cardiac

Number Of Work Stations

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