Your Name
Your Email Address
Facility Or Company Name
Phone Number
Fax Number
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 An 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