| Instructions: |
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| 1. | Print this form from the Web. | |
| 2. | Fill in this form indicating the equipment to be quoted by Novus for Buy Back. | |
| 3. | FAX completed form to number below: | |
|
Barbara Birdwell PHONE (615) 468-1151 FAX (615) 468-1150 193 - G Polk Ave Nashville, TN 37210 |
| Equipment Owner Information | Contact Name: |
| Company Name: | Telephone Number: |
| E-mail Address: | Location of Equipment: |
| Company Address: | |
| Condition of Equipment: | |
| FAX Number: | When Available: |
| Type and Description of Equipment | Non-Nortel Part # | NT Part # | Qty. |
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Notes: