Factormed: Quote

Technical assistance quote

Please fill in the form below to ask for a quote from Factormed.

Purchases made privately can be made directly through the website www.aboutmedical.pt.

The fields marked with an asterisk (*) are mandatory.

Mention if possible the following: type and model of equipment, quantity, brand, serial number and brief description of failure or problem

Personal Data

Email *

Name of the Company/Institution *

Person in charge *

NIF *

Telephone *

Client Type: *

Choose the type of client:

Type of equipment for a quote:

Model of equipment:

Quantity:

Brand of equipment:

Serial number of equipment:

Brief description of failure or problem:

Mobile

Address

Zip code

District

Medical Specialities

Technical Director

Person in charge of purchasing

Usual suppliers

Schedule

Banking information

Message