Modality:

"Choose from list" Anesthesia Angio-Suite Beds Bone Densitometer C-Arm Cath-Lab Chemistry Analyzer CT Scanner Dental Dialysis Dose Calibrator DSA Fetal Monitor Film Viewer Film Changer Gamma Camera Injector Lab Laser Camera Linear Accelerator Lithotriptor Mammography MRI Multi- Imager Nuclear Computer Portable X-Ray Processor R & F Room Rad Room Radiation Therapy Remote Room SPECT System Stress Surgery Trailer Ultrasound Urology Suite Vascular Doppler Video Printer X-Ray OTHER

Manufacturer:

"Choose from list" Acoma Acuson ADAC ADR AECL AGFA Aloka American Medical Product Amrad Ausonics AVP Baxter Bennett Biosound Bruel & Kjaer Calumet Capintec Cascade CGR Continental Corometrics Diasonics Dornier Drake Willock Dunn Dupont Elema Schonander Ellis & Watts Elscint Fischer Fonar Fuji Gambro General Electic H/P Hitachi Honeywell Imex Interspec J & J Jameson Kermath Kodak Konica Kontron Kramex Litton Lorad Matrix Medasonics Medrad Mitsubishi Odelft OEC Philips Physio Control Picker Pie Medical Precise Optix Quantum Raytheon S & S Scantronics Schiff Schonander Shimazdu Siemens Sony Sopha Summit Technicare Technomed Teknar Theratronics Toshiba Trans World Universal Varian Vingmed Xerox Xonics OTHER

Model or Type:

Age of Equipment:

1 Yr old 2 Yrs old 3 Yrs old 4 Yrs old 5 Yrs old 6 Yrs old 7 Yrs old 8 Yrs old 9 Yrs old 10 Yrs old 11 Yrs old 12 Yrs old 13 Yrs old 14 Yrs old 15 Yrs old 16 Yrs old 17 Yrs old 18 Yrs old 19 Yrs old 20 Yrs old Older Than 20 Yrs New

Organization:

First Name:

Last Name:

E-Mail:

Phone:

Fax:

Other Information: