Ultrasound Installation Card Click here to download PDF version. Date MM slash DD slash YYYY Installation LocationLocation Name*(where installed)Contact*(full name and title):Owner (if different)Street Address:*Hospital Name:*Suite:*Clinic Name:*City, State, ZIP:*Department:*E-mail Address:* Phone:Fax:System InformationModality*Select OptionDRUltrasoundModality - Ultrasound*Select OptionCardiovascular/Vascular (CV)General ImagingPoint of CareVeterinarianWomen's HealthSystem Model*Serial Number*Software Version*Options*Detector/Probe Part Number/Serial NumbersPart Number 1*Serial number 1*Part Number 2Serial number 2Part Number 3Serial number 3Part Number 4Serial number 4Part Number 5Serial number 5Add Part Numbers/Serial Numbers Add Probe Part Numbers/Serial Numbers Part Number 6Serial number 6Part Number 7Serial number 7Part Number 8Serial number 8Part Number 9Serial number 9Part Number 10Serial number 10Peripheral Part Numbers/Serial NumbersPeripheral Part Number 1Serial Number 1Description Number 1Peripheral Part Number 2Serial Number 2Description Number 2Peripheral Part Number 3Serial Number 3Description Number 3Peripheral Part Number 4Serial Number 4Description Number 4Peripheral Part Number 5Serial Number 5Description Number 5Seller / Customer InformationInstaller's NameInstall Date* MM slash DD slash YYYY Customer Name*TitleCustomer Signature*Signature Confirmation*By selecting this check box, the customer acknowledges that the Customer Signature field will server as their digital signature. Agree Disagree Date MM slash DD slash YYYY Comments:* Mandatory Fields to be populated by Sales Representative ** Customer's signature indicates successful installation and that the system(s), probe(s), and any peripherals have been accepted. *** If this is not the customer's mailing address, please list the mailing address in the comments section. Form NotificationEnter the email address for the person who should receive this form Email Confirmation* Enter Email Confirm Email Email Confirmation 2 Enter Email Confirm Email Email Confirmation 3 Enter Email Confirm Email CAPTCHA Δ