Procurement Form

1
What is your name?* This field is required.
First Name
Last Name
2
What is your phone Number* This field is required.
Area Code
Phone Number
3
What is the best Email to reach you?* This field is required.
example@example.com
4
What is your company name?* This field is required.
5
What is your job title?* This field is required.
6
What is your Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
7
(First Device) What is your reason for selling this device?* This field is required.
8
(First Device) Please select your first device from this list for appraisal. * This field is required.If your device is not on this list, please select "My device is not on this list" to continue.
Please Select
Please Select
MY DEVICE IS NOT ON THIS LIST
Allergan Diamond Glow
Allergan CoolSculpting Elite
Alma Soprano
BTL Aesthetics Cellutone
BTL Aesthetics EmBody
BTL Aesthetics EmFace
BTL Aesthetics Emsculpt
BTL Aesthetics Emsculpt NEO
BTL Aesthetics Emsella
BTL Aesthetics Exilis
BTL Aesthetics Exion
BTL Aesthetics Vanquish ME
Candela GentleMax Pro
Candela Picoway
Capture
Cartessa Vivace
Cutera Excel HR
Cutera Excel V+
Cynosure Apogee Elite
Cynosure Picosure
Cynosure Potenza
Deka MonaLisa
Envy Medical SilkPeel
Erchonia Emerald
Erchonia Zerona
Frost Lite Chiller
HK Lipo Vallet
Hydrafacial
InMode Bodytite
InMode Define
InMode Embrace
InMode Evolve
InMode Ignite
InMode Morpheus 8
InMode Optimas
InMode Votiva
Lutronic LaseMD
Lumenis LightSheer
Lumenis M22
Lumenis Trilift
Lutronic Spectra
Lutronic Clairty II
Merz Ultherapy Ulthera
Neograft 1.0
Nitronox
Palomar Icon
Pronox
Sciton BBLs
Sciton Halo
Sciton Joule
Solta Clear & Brilliant
Solta Fraxel Dual
SHEnB Scarlet S
Vectra
Venus Concept Legacy
Venus Concept Viva
Viol SylfirmX
VaserLipo
Zimmer Cryo
Zimmer Zwave
9
(First Device) Hi! It looks like your device is not on our acceptable device list. We are still happy to appraise it but will be invoicing you $89.99 for the appraisal of your machine. If you have more than one machine that is not on our list to be appraised, it will be $49.99 per device appraisal. We will contact you following submission to invoice you directly. Do you wish to continue?
YESNO
10
(First Device) Do you own this machine or have a loan to pay off? If so, how much is your payoff amount?* This field is required.
11
(First Device) Where was the device originally purchased?* This field is required.
Directly from the manufacturer
Other
Third party
12
(First Device) Device for Sale (Manufacture Date, Make & Model)* This field is required.
13
(First Device) Describe any hand-pieces & applicable accessories* This field is required.
14
(First Device) Detail Usage (Pulse Counts, Hours, etc.)* This field is required.
15
(First Device) Condition of Equipment Submitted* This field is required.
Fair
Good
Very Good
Excellent
16
(First Device) Please submit photos of the machine for faster appraisal times.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
17
Do you have another device to submit?* This field is required.
YESNO
18
(Second Device) What is your reason for selling this device?
19
(Second Device) Please select your first device from this list for appraisal. If your device is not on this list, please select "My device is not on this list" to continue.
Please Select
Please Select
MY DEVICE IS NOT ON THIS LIST
Allergan Diamond Glow
Allergan CoolSculpting Elite
Alma Soprano
BTL Aesthetics Cellutone
BTL Aesthetics EmBody
BTL Aesthetics EmFace
BTL Aesthetics Emsculpt
BTL Aesthetics Emsculpt NEO
BTL Aesthetics Emsella
BTL Aesthetics Exilis
BTL Aesthetics Exion
BTL Aesthetics Vanquish ME
Candela GentleMax Pro
Candela Picoway
Capture
Cartessa Vivace
Cutera Excel HR
Cutera Excel V+
Cynosure Apogee Elite
Cynosure Picosure
Cynosure Potenza
Deka MonaLisa
Envy Medical SilkPeel
Erchonia Emerald
Erchonia Zerona
Frost Lite Chiller
HK Lipo Vallet
Hydrafacial
InMode Bodytite
InMode Define
InMode Embrace
InMode Evolve
InMode Ignite
InMode Morpheus 8
InMode Optimas
InMode Votiva
Lutronic LaseMD
Lumenis LightSheer
Lumenis M22
Lumenis Trilift
Lutronic Spectra
Lutronic Clairty II
Merz Ultherapy Ulthera
Neograft 1.0
Nitronox
Palomar Icon
Pronox
Sciton BBLs
Sciton Halo
Sciton Joule
Solta Clear & Brilliant
Solta Fraxel Dual
SHEnB Scarlet S
Vectra
Venus Concept Legacy
Venus Concept Viva
Viol SylfirmX
VaserLipo
Zimmer Cryo
Zimmer Zwave
20
(Second Device) Hi! It looks like your device is not on our acceptable device list. We are still happy to appraise it but will be invoicing you $89.99 for the appraisal of your machine. If you have more than one machine that is not on our list to be appraised, it will be $49.99 per device appraisal. We will contact you following submission to invoice you directly. Do you wish to continue?
YESNO
21
(Second Device) Do you own this machine or have a loan to pay off? If so, how much is your payoff amount?
22
(Second Device) Where was the device originally purchased?
Directly from the manufacturer
Other
Third party
23
(Second Device) Device for Sale (Manufacture Date, Make & Model)
24
(Second Device) Describe any hand-pieces & applicable accessories
25
(Second Device) Detail Usage (Pulse Counts, Hours, etc.)
26
(Second Device) Condition of Equipment Submitted
27
(Second Device) Please submit photos of the machine for faster appraisal times.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
28
Do you have another device to submit?
YESNO
29
(Third Device) What is your reason for selling this device?
30
(Third Device) Please select your first device from this list for appraisal. If your device is not on this list, please select "My device is not on this list" to continue.
Please Select
Please Select
MY DEVICE IS NOT ON THIS LIST
Allergan Diamond Glow
Allergan CoolSculpting Elite
Alma Soprano
BTL Aesthetics Cellutone
BTL Aesthetics EmBody
BTL Aesthetics EmFace
BTL Aesthetics Emsculpt
BTL Aesthetics Emsculpt NEO
BTL Aesthetics Emsella
BTL Aesthetics Exilis
BTL Aesthetics Exion
BTL Aesthetics Vanquish ME
Candela GentleMax Pro
Candela Picoway
Capture
Cartessa Vivace
Cutera Excel HR
Cutera Excel V+
Cynosure Apogee Elite
Cynosure Picosure
Cynosure Potenza
Deka MonaLisa
Envy Medical SilkPeel
Erchonia Emerald
Erchonia Zerona
Frost Lite Chiller
HK Lipo Vallet
Hydrafacial
InMode Bodytite
InMode Define
InMode Embrace
InMode Evolve
InMode Ignite
InMode Morpheus 8
InMode Optimas
InMode Votiva
Lutronic LaseMD
Lumenis LightSheer
Lumenis M22
Lumenis Trilift
Lutronic Spectra
Lutronic Clairty II
Merz Ultherapy Ulthera
Neograft 1.0
Nitronox
Palomar Icon
Pronox
Sciton BBLs
Sciton Halo
Sciton Joule
Solta Clear & Brilliant
Solta Fraxel Dual
SHEnB Scarlet S
Vectra
Venus Concept Legacy
Venus Concept Viva
Viol SylfirmX
VaserLipo
Zimmer Cryo
Zimmer Zwave
31
(Third Device) Hi! It looks like your device is not on our acceptable device list. We are still happy to appraise it but will be invoicing you $89.99 for the appraisal of your machine. If you have more than one machine that is not on our list to be appraised, it will be $49.99 per device appraisal. We will contact you following submission to invoice you directly. Do you wish to continue?
YESNO
32
(Third Device) Do you own this machine or have a loan to pay off? If so, how much is your payoff amount?
33
(Third Device) Where was the device originally purchased?
Directly from the manufacturer
Other
Third party
34
(Third Device) Device for Sale (Manufacture Date, Make & Model)
35
(Third Device) Describe any hand-pieces & applicable accessories
36
(Third Device) Detail Usage (Pulse Counts, Hours, etc.)
37
(Third Device) Condition of Equipment Submitted
38
(Third Device) Please submit photos of the machine for faster appraisal times.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
39
Do you have another device to submit?
YESNO
40
(Fourth Device) What is your reason for selling this device?
41
(Fourth Device) Please select your first device from this list for appraisal. If your device is not on this list, please select "My device is not on this list" to continue.
Please Select
Please Select
MY DEVICE IS NOT ON THIS LIST
Allergan Diamond Glow
Allergan CoolSculpting Elite
Alma Soprano
BTL Aesthetics Cellutone
BTL Aesthetics EmBody
BTL Aesthetics EmFace
BTL Aesthetics Emsculpt
BTL Aesthetics Emsculpt NEO
BTL Aesthetics Emsella
BTL Aesthetics Exilis
BTL Aesthetics Exion
BTL Aesthetics Vanquish ME
Candela GentleMax Pro
Candela Picoway
Capture
Cartessa Vivace
Cutera Excel HR
Cutera Excel V+
Cynosure Apogee Elite
Cynosure Picosure
Cynosure Potenza
Deka MonaLisa
Envy Medical SilkPeel
Erchonia Emerald
Erchonia Zerona
Frost Lite Chiller
HK Lipo Vallet
Hydrafacial
InMode Bodytite
InMode Define
InMode Embrace
InMode Evolve
InMode Ignite
InMode Morpheus 8
InMode Optimas
InMode Votiva
Lutronic LaseMD
Lumenis LightSheer
Lumenis M22
Lumenis Trilift
Lutronic Spectra
Lutronic Clairty II
Merz Ultherapy Ulthera
Neograft 1.0
Nitronox
Palomar Icon
Pronox
Sciton BBLs
Sciton Halo
Sciton Joule
Solta Clear & Brilliant
Solta Fraxel Dual
SHEnB Scarlet S
Vectra
Venus Concept Legacy
Venus Concept Viva
Viol SylfirmX
VaserLipo
Zimmer Cryo
Zimmer Zwave
42
(Fourth Device) Hi! It looks like your device is not on our acceptable device list. We are still happy to appraise it but will be invoicing you $89.99 for the appraisal of your machine. If you have more than one machine that is not on our list to be appraised, it will be $49.99 per device appraisal. We will contact you following submission to invoice you directly. Do you wish to continue?
YESNO
43
(Fourth Device) Do you own this machine or have a loan to pay off? If so, how much is your payoff amount?
44
(Fourth Device) Where was the device originally purchased?
Directly from the manufacturer
Other
Third party
45
(Fourth Device) Device for Sale (Manufacture Date, Make & Model)
46
(Fourth Device) Describe any hand-pieces & applicable accessories
47
(Fourth Device) Detail Usage (Pulse Counts, Hours, etc.)
48
(Fourth Device) Condition of Equipment Submitted
49
(Fourth Device) Please submit photos of the machine for faster appraisal times.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
50
Do you have another device to submit?
YESNO
51
(Fifth Device) What is your reason for selling this device?
52
(Fifth Device) Please select your first device from this list for appraisal. If your device is not on this list, please select "My device is not on this list" to continue.
Please Select
Please Select
MY DEVICE IS NOT ON THIS LIST
Allergan Diamond Glow
Allergan CoolSculpting Elite
Alma Soprano
BTL Aesthetics Cellutone
BTL Aesthetics EmBody
BTL Aesthetics EmFace
BTL Aesthetics Emsculpt
BTL Aesthetics Emsculpt NEO
BTL Aesthetics Emsella
BTL Aesthetics Exilis
BTL Aesthetics Exion
BTL Aesthetics Vanquish ME
Candela GentleMax Pro
Candela Picoway
Capture
Cartessa Vivace
Cutera Excel HR
Cutera Excel V+
Cynosure Apogee Elite
Cynosure Picosure
Cynosure Potenza
Deka MonaLisa
Envy Medical SilkPeel
Erchonia Emerald
Erchonia Zerona
Frost Lite Chiller
HK Lipo Vallet
Hydrafacial
InMode Bodytite
InMode Define
InMode Embrace
InMode Evolve
InMode Ignite
InMode Morpheus 8
InMode Optimas
InMode Votiva
Lutronic LaseMD
Lumenis LightSheer
Lumenis M22
Lumenis Trilift
Lutronic Spectra
Lutronic Clairty II
Merz Ultherapy Ulthera
Neograft 1.0
Nitronox
Palomar Icon
Pronox
Sciton BBLs
Sciton Halo
Sciton Joule
Solta Clear & Brilliant
Solta Fraxel Dual
SHEnB Scarlet S
Vectra
Venus Concept Legacy
Venus Concept Viva
Viol SylfirmX
VaserLipo
Zimmer Cryo
Zimmer Zwave
53
(Fifth Device) Hi! It looks like your device is not on our acceptable device list. We are still happy to appraise it but will be invoicing you $89.99 for the appraisal of your machine. If you have more than one machine that is not on our list to be appraised, it will be $49.99 per device appraisal. We will contact you following submission to invoice you directly. Do you wish to continue?
YESNO
54
(Fifth Device) Do you own this machine or have a loan to pay off? If so, how much is your payoff amount?
55
(Fifth Device) Where was the device originally purchased?
Directly from the manufacturer
Other
Third party
56
(Fifth Device) Device for Sale (Manufacture Date, Make & Model)
57
(Fifth Device) Describe any hand-pieces & applicable accessories
58
(Fifth Device) Detail Usage (Pulse Counts, Hours, etc.)
59
(Fifth Device) Condition of Equipment Submitted
60
(Fifth Device) Please submit photos of the machine for faster appraisal times.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
61
Thank You!

Please select Next to SUBMIT
62
We appreciate you choosing MNML Aesthetics!

Our procurement team will be in contact with you shortly. Please select "submit" to complete the form.
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