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SELLER INFORMATION
First Name
Last Name
Company
Address 1
Address 2
City
State
Postal Code
Email address
Area code
Phone
Fax
EQUIPMENT INFORMATION
Sell only
Yes
No
Asking Price
Manufacturer
Pulse count / total hours
Model
Last date serviced
Overall
condition
New
Used
Needs Repair
Is the equipment currently on a lease?
Yes
No
Year
2006
2005
2004
2003
2002
2001
2000
1999
1998
Serial number
If yes, is it transferable?
Yes
No
Original packaging
Yes
No
Factory warranty
Yes
No
Additional information
(hand pieces, fibers, manuals, safety glasses, chillers,
etc)
:
this where you put company info
