Amber Diagnostics is pleased to offer a full range of financing & lease options which are designed to facilitate your particular needs, while working within your given budget. Our goal is to make your acquisitions easy with only one vendor to work with.

To insure security and confidence, we are providing a very basic application. Upon completion of this form, an Amber representative will contact you to receive more personal information on a secured transmission.

Equipment Financing Application Form Name (Required) Profession / Industry Please Select Dealer / Wholesaler Service / Installation Co. Medical Doctor Director / Administrator Importer / Exporter Other (Required) Street Address City State Zip Code Country Phone Number Fax E-mail Address (Required) Type of Equipment Select One Bone Densitometers C-Arm Chiropractic X-Ray Rooms CT Scanner Laser Cameras Mammography MRI Nuclear Camera PET / CT Scanner Portable X-rays Printer Processors Radiographic & Fluoro Rooms Radiographic Rooms Special Procedure Rooms Ultrasounds Urology X-Ray accessories (Required) Lease Amount (Required) Date Needed Select a Month January February March April May June July August September October November December Select a Year 2008 2009 2010 2011 2012 2013 Comments / Questions Information provided is for the sole purpose of this equipment financing application. Amber Diagnostics guarantees to never share your personal information.