Contract Quote

Contract Quote Ultrasound Solutions Corp

Ultrasound Solutions Corp offers three levels of service contracts to fit the needs of any practice. Complete the following form and we’ll quote our price to provide you with the peace of mind that comes with knowing you’re covered when you need ultrasound service. Check out our Service Contracts page to learn more about each contract level to determine which is best for you.

If you prefer you can fill out a word document and email or fax it to us.

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Online Quote

System Location:

Parent Company:
Address:
City:
State:
Zip:
On-site Contact:
Department:

Contact Information:

Contact Name:
Department:
Business Name:
Email:
Address:
City:
State:
Zip:
Phone:

System To Be Covered:

System Mfg:
System Model:
Serial Number:
Condition:
 

Probes:

Probe Model:
Serial Number:
Condition:
Probe Model:
Serial Number:
Condition:
Probe Model:
Serial Number:
Condition:

Peripherals:

VCR Model:
Serial Number:
Condition:
Color Printer Model:
Serial Number:
Condition:
B/W Printer Model:
Serial Number:
Condition:

Known Equipment Issues:

Identified Problems:

Contract Types:

Please give me a quote on the following contract types and term lengths.
Contract:
Gold Plan Silver Plan Bronze Plan
Term Years:
1yr 2yr 3yr 4yr
Payment Preference:
3mo 6mo 12mo
Comments:

Referred By:

Name:
Facility:
Phone: