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Cart Fair/Trade Show Equipment Request Form
(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?
Shipping
Picking up
Ship to (Facility):
*
Contact's Name:
*
Contact's Phone#:
Shipping Address:
*
Lift Gate Required (yes or no):
Yes
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:
Yes
No
If Different:
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:
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About Us
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Eval Request
(877) 856-6441 | (601) 399-5060 (fax) |
Email
| Copyright © 2000-2010 Howard Medical, Inc.
Howard Medical is a division of
Howard Industries Inc.