R/F Room Spec Sheet

R/F Room Spec Sheet
Company Name: * Required
Contact Name: * Required
Country: * Required
State: * Required
Email: * Required
Phone: * Required

Manufacturer: * Required
Year: (i.e. 2010) * Required
Model: * Required
Functional?: * Required	Yes No
Installed?: * Required	Installed De-Installed
Address Where Installed:
System Serial Number:
Mobile?:	Yes No
Generator Model and Size:
X-Ray Tube Model, Size, and Age:
Image Intensifier Size and Age:
Digital Image Intensifier:
Table Model:
Tilt/Motion:
Collimator Model:
If Camera what model?:
Monitor Model and Quantity:
Monitors Ceiling Mounted?:
Digital?:
Software Release:
Remote Room?:
Wall Bucky or Chest Stand:
Phototimed?:
Patients per day:
Upgrades & Year completed :
Reason for Sale:
Availability Date:
Asking Price:
Who services the equipment?:
Site ID:
Location Type:
Loading Dock at Facility?:	Yes No
Picture Attachment(s):