Request Quote

Instructions

Full Name

Your full name e.g John Doe

Email Address

Enter your email address.

Telephone Number

Include country code e.g 256712345678

Company/Organisation

The name of the company or organisation that you work for.

Address

The address where your company/organisation is located.

Method of contact

Phone Number

Both

What is your preferred method of contact?

Services

Which service(s) are you interested in?

Procurement of biomedical supplies, consumables and equipment

Re-order	Product	Quantity	Weight	Operations
	Product Name of the supplies/consumables/equipment	Quantity The quantity of the product	Item weight

more items

Installation, Repair and Maintenance of Biomedical equipment

Re-order	Equipment	Service	Quantity	Weight	Operations
	Equipment Name of the equipment	Service Type of service required for the equipment.	Quantity How many of this type of equipment need the selected service	Item weight

more items

Biomedical equipment calibration

Re-order	Equipment	Quantity	Weight	Operations
	Equipment Name of the equipment to calibrate	Quantity Enter the number of this equipment to calibrate.	Item weight

more items

Deadline

Yes

Does your request have a deadline delivery of requested service?

Deadline

Notes

Provide any additional information in regards to this request.