Your Name

Your Email Address

Facility Or Company Name

Phone Number

Fax Number

Manufacturer

Date Of Manufacture

Model

Software Level

Is The System Color Yes No

Does The System Have Doppler Yes No

What Calculations Packages Does It Have

Does It Do Tissue Harmonics Yes No

Probes, Please List The Model Number, Frequency and Type i.e. (PVF703NT, 7.5 MHz, Linear) 

Type Of VCR

Type Of Printer

Film Camera

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 Or Accessories