Purpose Medical, Inc works with banking institutions, medical centers, and private medical offices to redeploy their surplus capital medical equipment. We would like to know about any equipment that your facility is considering selling. Please take a moment to complete this information form to provide us with a better understanding of your equipment. Upon arrival, our procurement manager will contact you to verify the information and provide you with a level of interest that Purpose Medical has for your item.

Thank you for considering Purpose Medical for your medical equipment financial recovery company.

Your Contact Information
First Name:


Last Name:


Company Name:


Address:


City:


State/Province::


Zip:


Email:


Phone:


Fax:


Equipment Information

Product:


Manufacturer:


Year of Mfg:


Serial Number:


General Description:


Accessories included:


Equipment Condition:


Last serviced:


Why are you selling: