Cart Fair/Trade Show Equipment Request Form



Brands \| Med Carts \| Systems \| Hardware \| Services

(Only 1 cart per request)

*Indicates required field

*Sales Rep Requesting:

*Sales Rep's email address:

Event Information

*Name:

*Date of Event:

*Date Needed to Arrive:

Shipping Information

Picking up or shipping?

Ship to (Facility):

*Contact's Name:

*Contact's Phone#:

Shipping Address:

*Lift Gate Required (yes or no):

*Estimated Date of Return:

Additional Comments and Notes:

Cart Information

(All HI-Care based carts are white/grey
with 5" casters unless specified)
Cart Needed:

CPU:

Monitor:
(Up to 22" mounted to Howard arm unless specified)

Peripherals:

Accessory mounting options:
Pole with mounting bracket

Extended Mounting Bracket(not compatible
with Paradigm or HI-Care with general storage
drawer)

Accessories:
Sani wipes

Hand sanitizer

Sharps 1 QT

Sharps 2 QT

Mini waste

Small basket

Large basket

Basic Accessory Pack
(Includes pole,extended mounting bracket, Sani-wipes,
bracket,1 QT sharps, Mini waste,Small basket,
and Hand Sanitizer)

Comments, Cart/Drawer Configuration, Power System:

Marketing Materials:(Qty)

*Shipping to same Location as above:

Flooring
Tablecloth(s)
Pop-up Banner Stand
Givaways

Brochures:
Hi-Mobile
HI-Care
HI-Prodigy
HI-Paradigm
Hi-Pinnacle
Tri-fold Folder
Hi-Med/Pinnacle Booklet

Additional Comments and Notes: