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Selectable™ Collimator — Quotation Request

Please fill out the following form as accurately and completely as possible to receive a written quotation on the Selectable™ collimator.


I Would Like To Receive:
Product Literature
Written Quotation


Please send specific information for:

X-ray collimators

Manual collimator
Selectable collimator
Other collimator
Complete X-ray collimator line


Remanufactured Diagnostic Imaging Systems

Remaufactured GE R/F system
Remanufactured GE AMX portable
Remanufactured GE CT system
Remanufactured OEC C-arm
Remanufactured Liebel-Flarsheim Uro suite
Other remanufactured system
Complete remanufactured diagnostic imaging line


Radiotherapy Products

Radiotherapy simulators
Shielding block cutters
Beam compensator milling systems
X-ray cassette holders
Breast incline board
Radiotherapy thermoplastic
Calipers
Head & neck immobilization
Foam blocks, alloy, other supplies
Other radiotherapy product
Complete radiotherapy product line

(list additional interests in text box provided below)


My Personal Information:

First Name

Last Name

Middle Initial

Title

Organization

Work Phone

Fax

E-mail Address (required)

Street Address

City

State

Zip Code

Country


Contact Details

The above information is also my “ship to” address:
yes no (If no, please provide “ship to” in text box provided below)

Please contact me via:

I would also like someone to call me:
yes no


Quote Item 1

Please enter quantity and select collimator model.
(enter qty.)


Selectable Collimator Options

Please choose from our list of available Selectable collimator options.
Detent, 90° Rotation Kit (CM-259)
Tape Measure Kit (CM-314)
Accessory Track Kit (CM-318)


Power Cable Options

Please choose from our list of available substitute power cable options.
(20 ft. cable is supplied as standard equipment)
30 ft. substitution (CM-320)
35 ft. substitution (CM-321)
40 ft. substitution (CM-322)
45 ft. substitution (CM-323)

Additional quote items or comments may be listed in the text box provided below.


Other:

I first learned of Huestis Medical from:

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Trade Show


Other


Additional Comments


 

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© 2001 Huestis Medical. All rights reserved. Specifications subject to change without notice.
Please contact us at 401.253.5500 (M-F, 8:00 am-5:00 pm, EST, USA) or sales@huestis.com for sales or technical assistance.