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    Info Request

    Please complete all required fields* so that we can respond quickly to your request and provide you with the mobile lab that is right for you.


    *Hospital / Clinic / Company:


    *Full Name:


    *Position:



    *Address / City / State / Zip:



    *Country:



    *Phone Number:



    Fax Number:



    *Email:



    Reason for needing Mobile:

    Temporary demand

    Replacement

    Upgrade

    Start up

    Other (Please Specify)



    What system do you currently have?

    None

    Other



    Specific Length of Rental

    1-3 months

    3-6 months

    1-2 years

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