Request an Appraisal

Please use the form below for online equipment appraisal submittal. A representative will contact you shortly.

- Name*
- Email*
- Description of Equipment*
- Model #*
- Acquisition Cost (if available)
- Healthcare Organization Name*
- Phone*
- Equipment Manufacturer*
- Manufacture Date
  Date Format: MM slash DD slash YYYY
- Estimated Condition of Equipment*
Upload Images of Equipment (max of 3 images)
Drop files here or

Accepted file types: jpg, gif, png, pdf.