Equipment Worksheet

Please fill out the following worksheet for equipment you would like to sell, then click "submit".  An ICS representative will contact you.

Contact Name:        

Facility Name:

Email:

Phone Number:

Fax:                         

Preferred contact method:

Phone  Fax  Email

EQUIPMENT SPECIFICATIONS

OEM:

Model:

Year:

Software Version:

Availability Date:

MRI Tesla: .2  .5  1.0  1.5  Other

MRI Type: Fixed  Mobile  Modular  Transportable

MRI Magnet Type: Permanent  Resistive  Super Conducting

Cryogen: Yes  No

MRI Coils: Please List:

Gradient Strength: MTM SR 

Host Computer: 

Sequences/Options:

Condition: (1-10, 10 =Excellent)

CT Tube Size:

CT Generator Size:

CT Gantry Counts:

CT Tube Counts:

Second Console: YES  NO

Under Service Contract YES  NO

DICOM: YES  NO

Mobile Trailer Manufacturer:

Mobile Trailer Year:

Trailer Condition (1-10, 10 =Excellent):

Asking Price:

Comments: