Rad Room Data Sheet
Your Name
Your Email Address
Facility Or Company Name
Phone Number
Fax Number
Manufacturer
Date Of Manufacture
Generator Model
Is it Single Or Three Phase Three Phase Single Phase
Is It High Frequency No Yes
Maximum MAs
Does It Have Phototiming Yes No
Table Model
Does Table Elevate No Yes
Is It 2 Way Or 4 Way 2 Way 4 Way
Type Of Tube Stand Overhead Integrated Floor To Wall
Model and Age Of The X Ray Tube
Does The System Have A Tomo Attachment
Is There a Wall Bucky Yes No
Is There a Processor Yes No Model
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