Medical Equipment For Sale Form

Request Date*

Date

Name*

First NameLast Name

Practice or Facility Name*

Address (Location of the Equipment)*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number*

Please enter a valid phone number.

Email*

example@example.com

List of Equipment for Sale*

	Equipment Type	Make/Model	Serial Number	Current Condition	Desired Price
1
2
3
4
5
6
7
8
9

File Upload

Please upload pictures of the actual equipment available.

Access Type for Equipment Removal (Stairs, Elevator, Ground Floor):*

Are we able to access the equipment during business hours? (9AM-5PM M-F)*

Additional Information

Once we receive your form submission, our team will review the details provided. We may reach out via phone or email if we have any additional questions. Our evaluation process takes 5-7 business days, during which we'll assess various factors, including our current inventory, the condition of the equipment, availability of parts, and current customer needs. Please note that submitting this form does not guarantee that Med-Stat Medical will purchase the equipment. Our decision will be based on a comprehensive evaluation of all relevant factors.

Please verify that you are human*