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Equipment info
Kind
*
Agilia Injectomat MC - Syringe pump
AirCard - Wireless broadband modem
AlcoTest - Breathalyzer 6810MED
AM-140 - Upright controlled storage, 140L
BG323 - Ambulatory volumetric infusion pump
BPM M3 - Blood pressure measuring device
BPM M6 - Blood pressure measuring device
BPM MRI compatible - Non-Invasive blood pressure monitor, MRI-compatible
BPM705 - Blood pressure measuring device, including printer
BVI3000 - BladderScan volume instrument
Cabinet Safe - Full-size secure archive cabinet safe, 325L
cart base for Eli - cart for Eli ECG machines with swivel casters
Cart ELI-250 - Cart ELI-250 basic configuration
CC-110 - Climate chamber, 110L
CMS50D - Pulse Oximeter
Compact Cooled Incubator - Compact cooled incubator, 18L
Compact Lockable Cabinet - Compact Lockable Cabinet
Crono S-PID-50 - Crono infusion pump
Double Cabinet Safe - Cabinet Safe; Double-size Secure archive cabinet Safe
DryBath Incubator 230V - Digital Dry Bath Incubator
EBA20 - Ambient portable centrifuge, fixed angle rotor
EBA200 - Ambient bench-top centrifuge, fixed angle rotor
ECG ELI-10 - Lightweight 12-lead paperless ECG
ECG ELI-150 - Compact 12-lead printing ECG
ECG ELI-230 - Compact 12-lead printing ECG
ECG ELI-250 - Full-size 12-lead printing ECG
Eppendorf 5702R - Refrigerated bench-top centrifuge, swing-out rotor
Fax - Fax
Fax / Printer / Copier / Scanner - All-in one printer
FMS-EU - Infusomat FMS 230V
Fresco17 - Refrigerated bench-top microlitre centrifuge, swing-out rotor
Frio Thermometer - Frio Thermometer
FV20-140 - Upright freezer, 140L
FV20-35 - Compact Freezer
FV20-60 - Compact basic freezer, 60L
FV20-70 - Upright compact freezer, 70L
FV30-95 - Upright -30c freezer, 95L
FV40-215 - Chest -40c freezer, 200L
FV60-75 - Chest -60c freezer, 75L
FV80-10 - Upright ultra low freezer, 10L
FV80-450 - Upright UltraLow Freezer 450 litres
FV80-55 - Upright ultra low freezer, 55L
FV80-650 - Upright UltraLow Freezer 650 litres
FV80-75 - Chest ultra low freezer, 75L
FV80-85 - Chest ultra low freezer, 84L
GSI Tympstar Pro - Comprehensive Middle Ear Analyzer
Haemo - Ambient bench-top capillaries centrifuge, fixed angle
HB201+ - Hemoglobine analyzer
Highspeed fixed angle rotor - Highspeed fixed angle HighConic rotor for Primo(R)
Holter 5000 - 12-Lead Holter TLC 5000
Holter 9803 - Holter 3-lead paperless ECG
HV Dewar - IATA CryoShipper
Incub IL10 - Compact incubator, 10L
Incubator - Compact incubator, 23L
IncuShakerMini - Shaking Incubator Mini
Infusomat Space - Volumetric infusion pump
IR Scanner - Linear Imager Scanner
L200 - Ambient bench-top centrifuge, fixed angle rotor
L400 - Ambient bench-top centrifuge, swing-out rotor
L400 Cyto - Ambient bench-top centrifuge, Cytospin configuration
L400R - Refrigerated bench-top centrifuge, swing-out rotor
LabScale (PA3202) - Lab scale, readout 0,01g, max 3100g
LabScale 0,001g - 200g - Lab scale, readout 0,001g, max 200g
LabScale 0,01g - 650g - Lab scale, readout 0,01g, max 650g
LabScale 0,01mg - 100g - Lab scale, readout 0,01mg, max 100g
LabScale 0,1g - 1000g - Lab scale, readout 0,1g, max 1000g
Laptop inc MS Office - Laptop incl MS Office
Lockable Cabinet - Compact Cabinet, with 2 doors and a lock
Logger Ultralow -100 - -100c to +40c temperature logger
Medifuge - Ambient bench-top centrifuge, DualSpin rotor
Megafuge 16R - Refrigerated bench-top centrifuge, swing-out rotor
Microscope - SZX16 w/Heated Stage
Mikro 200R - Refrigerated bench-top centrifuge, fixed angle rotor
Mikro 220R - Refrigerated bench-top centrifuge, fixed angle rotor
MP mlh+ - Ambulatory syringe pump
Network temp logger - Network connected Temperature Logger
PDF LOG 300 - -35c to +75c temperature logger
PDF LOG 310 - -200c to +70c temperature logger
PDF Logger -40 - -40c to +70c temperature logger
Perfusor Space EU - Syringe Pump
Perfusor Space US - Syringe Pump
Personal Scale - Personal scale, readout 0,1kg, max 200kg
Personal Scale BMI - Personal scale incl stadiometer, readout 0,1kg, max 250kg
Personal Scale Portable - Personal scale, readout 0,1kg, max 200kg
Pico17 - Ambient bench-top microlitre centrifuge, fixed angle rotor
Pipette Ref2 - Reference® 2 pipette
Primo - Ambient bench-top centrifuge, swing out rotor
PrimoR - Refrigerated bench-top centrifuge, swing-out rotor
RAD-8 - Pulse oximeter
RF-140 - Upright refrigerator, 140L
RF-240 - Upright refrigerator, 240L
RF-30 - Compact basic Refrigerator
RF-300 - Upright refrigerator, 300L
RF-60 - Compact basic refrigerator, 60L
RF-600 Solid - Upright refrigerator, 600L
RF-70 - Upright compact refrigerator, 70L
RF-75 - Pharmacy Refrigerator 70L
RF-FV20 combo - Refrigerator Freezer upright combo
S4BU - Sense4BabyUnit
SBBAQP12US - Boiling Water Bath 12L
Smokerlyzer - Breath CO monitor
Spirodoc - USB Spirometer
Spirolab III - Portable desk top diagnostic spirometer
Stadiometer - Portable Height Meter
Surveyor CTS - Central telemetry system
Surveyor Router - Surveyor security router
Surveyor S4 - Central telemetry monitors
Surveyor S4 battery - Surveyor telemetry monitor (S4) battery
Sweat collection system - Standardized sweat tester for the diagnosis of cystic fibrosis
Swing-out ML Rotor - Highspeed Swing-out Microlitre rotor for Primo(R)
T 100 - Warm Water Bath
T34 NIKI - Ambulatory syringe pump
T34L - Ambulatory syringe pump
Testo 174T - Temperature logger
Testo 184 T4 - Temperature logger
TFA thermometer - LT-102 Laboratory thermometer
TS Pro4000 - Ear thermometer
UPS - Back-up power generator
UROFM - Uroflow Meter
Variocar - Mobile instrument trolley
VeinViewer - Infrared Vein Finder
VSM - Vital signs monitor
WattBike - Ergo bicycle test
Wheelchair Scale - Mobile chair scale
Wrist PO - Wrist pulse oximeter
ZP-200 - ZPoint node & display
ZP-CELL400 - ZPoint cellular gateway
ZP-CELL400ULT - ZPoint cellular gateway ULT
ZP-TEMP - ZPoint temperature sensor
ZP-TEMPULT - ZPoint Temperature Sensor ULT
Other
If "other" please specify
Serial number
*
Number of units
*
Old study info
Old sponsor
*
Old study nr. (internal)
*
Old study nr. (sponsor)
Old site nr.
*
New study info
New sponsor
*
New study nr. (internal)
*
New study nr. (sponsor)
New site nr.
*
Minimum rental period in months
*
0
6
12
18
24
36
48
60
Site / Delivery address info
Hospital / Institute
*
Department
Address
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Postal code
*
City
*
State
Country
*
Tel. of the contact at the site
*
Fax
Contact person at the site
*
E-mail address
*
Company info
Company name
*
Ordered by (name)
*
E-mail address
*
Start date new contract
*
Date Format: MM slash DD slash YYYY
Purchase/Order number (1)
Remarks
1) If applicable
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