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Surplus Equipment Information Form
Required information is in red.
Equipment Information
Equipment Manufacturer: Equipment Model #:
Equipment Serial #: Year of Manufacture:
Output Power: Output Frequency:
Input Voltage: Input Frequency:
Oscillator Tube Type: Power Control Type:

Is the equipment complete?Yes No
Photographs available?Yes No
Please list any missing or failed parts

What was the equipment used for?
Why was it taken out of service?
Was the equipment functional when removed from service?
Please list any accessory equipment
or spare parts included with this equipment

Seller's Information

Name First: Name Last:
Title: Company:
Address: City:   
State:     Postal Code:     Country:  
Telephone:    - 
Fax:   - 
How Would You Like Us To Contact You?       Call    Fax    Email

Equipment Location
(Please supply any information which differs from the above)

Address:        City:   
State:     Postal Code:     Country:  
Loading facilities and capabilities:   

*Enter Security Code: 8    


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East Coast Induction, Inc.
P.O. Box 2039
Brockton, MA 02305-2039
Telephone: (508) 587-2800
Fax: (508) 587-9079
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