Name of Person Submitting Request:

Organization Represented:

Organization Street Address:

Suite Number Or Address 2:

City:

State: Zip / Postal Code:

Country:
Telephone Number: Extension (If Applicable):
Facsimile Number:
E-mail Address:

Please Advertise The Following Equipment:
Separate Schedule Acceptable If Space Is Insufficient
Equipment: For Sale: For Bid (If Bid, Enter Bid Closing Date:

	Equipment Manufacturer	Model Number	Quantity	Unit Price (If Bid, Minimum Price US)	Full Description Including All Features
Item 1
Item 2
Item 3
Item 4
Item 5
Item 6

Special Notes :

Yes No I / We have read and agree to all terms as set forth in
Equipment Bid, Equipment Sale, and Equipment Advertising Terms as detailed herein

By this advertising request, I certify that I am authorized to offer such equipment for sale or bid for the organization I represent:

Please Initial:

Thank You for Advertising your equipment. Please select the following to submit:

To reset and start again: and return to top of form

** NOTE: ALL FIELDS ARE REQUIRED **

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