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New Customer Registration

Please fill out this entire form. Failure to provide complete information delays processing of this application.

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Company & Billing Address

Company Name:*

Attention:

Street Address:*

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Zip:*

Phone:*

Fax:

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Sales Representative:*

Shipping Address (if different)

Street Address:

City:

State:

Zip:

Officers/Owners

Name:*

Title:*

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Name:

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Will you require a purchase order?*
Yes

Is merchandise for resale?*
Yes

(if yes, please attach a copy of your resale certificate)

Is your company tax exempt?*
Yes

(if yes, please attach a copy of your resale certificate)

By clicking “Submit” I hereby certify that I am an authorized signor for the company listed above. I certify that the company assumes financial responsibility, ability and willingness to pay the invoices received from Echoserve, Inc. in accordance with the terms and conditions therein. In the event of nonpayment, the company agrees to pay all costs incurred for collection, including attorneys’ fees.

Optimal™Phantom

The Optimal™ Phantom is an easy-to-use tissue-mimicking phantom that evaluates the image quality and geometric accuracy of ultrasound systems with an operating frequency range of 2.25 MHz to 7.5 MHz.

(877) 386-3246

New Customer Registration

Company & Billing Address

Shipping Address (if different)

Company Information

Officers/Owners

Optimal™Phantom