Your Name
Your E mail Address
Facility Or Company Name
Phone Number
Fax Number
Manufacturer
Date Of Manufacture
Model
Is the system single or multi-slice Single Slice 2 Slice 4 Slice 6 Slice 8 Slice 10 Slice 12 Slice 16 Slice 32 Slice 64 Slice 128 Slice
If The System Is Helical, How Fast Can is do a Full Rotation 0.5 Second 1.0 Second 1.5 Second
Number Of Slices or Scan Seconds On Gantry Slices Scan Seconds
Number Of Slices Or Scan Seconds On Tube Slices Scan Seconds
Model and Heat Unit Rating Of The Tube
What is the Size Of The Generator
Number Of Consoles 1 2 3
Is There a 3D Workstation Yes No What Model
Type Of Computer
Software Level
Diagnostic Packages i.e. Angio, Dental
Type Of Storage Device
Is There An Imager Included Yes No Model
Who Is Servicing The System
When Is The System Available For Removal
When do You Need An Offer By
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