Portable X-Ray Data Sheet
Your Name
Your Email Address
Facility Or Company Name
Phone Number
Fax Number
Manufacturer
Date Of Manufacture
Model
Is The System Battery Or Electric Powered
Age And Type Of Batteries
Age Of The X Ray Tube
Maximum Mas
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