Used Equipment Information Form

Please provide the following contact information:

Name

Organization

Street Address

Address (cont.)

City

State

Zip/Postal Code

Work Phone

FAX

E-mail

Please provide the following product information:

Please provide us with the manufacturer and model number of your unit along
with a brief description of the condition of the unit and the serial number or date
of manufacture. If your product is something that we can post on our Web Site,
we will call you back once we receive your information

ABS Imaging Systems
Copyright © 1999 [ABS Imaging Systems]. All rights reserved.
Revised: 12/31/01