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
MRI Information
Manufacturer
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