Equipment Health Solution Quote

Equipment Health Solution Quote
Equipment Health Solution Quote

GPO Edition

Customer Information
Name of Organization
Contact Name
Contact Position/Title
Contact Phone Number
Contact Email Address
Number of Locations
Location Address

Street Address

Street Address Line 2

CityState

Zip Code
Primary contact EMSAR will utilize for scheduling and service needs, including the contact that will be utilized for the initial asset tagging schedule.
Location Point of Contact
Point of Contact Cell Phone
Point of Contact Email
Contact EMSAR will utilize for all medical device task action reminder emails, which will be sent from the EHS system 48 hours prior to each tasks due date.
Task Management Contact Name
Task Management Contact Email
Task Management Contact Email cannot be the same as Point of Contact Email.
Please use the following link to download the location provider Excel file. Complete the file and upload to continue.

Location Information
Location List

Cancelof
MWI Info
MWI Account Number
MWI Sales Rep
MWI Sales Rep Email
MWI TSS Rep
MWI TSS Rep
MWI TSS Rep Email
MWI TSS Rep Email
Equipment Tagging Estimate
Will this customer participate in EHS Installation Experience?
Standard Tagging Calculator
Equipment Tagging - up to 75 items $794.30 per site

Equipment Tagging - 76 to 125 items $1,344.00 per site

Equipment Tagging - Every item over 125 per location is $13.60 per item

For a more precise estimate please provide total number of locations with more than 125 and the total numbers of items at each locations.
# of locations with 75 items or less
Tagging Cost
# of locations with 76-125 items
Tagging Cost
# of items over 125
Tagging Cost
Total Locations
Total Tagging Cost
EHS Installation Experience Asset Tagging

This includes standard asset tagging PLUS setup, packaging removal, and functional testing.
Equipment Tagging - up to 45 items $2,025.00 per site

Equipment Tagging - 46 to 75 items $2,532.00 per site

Equipment Tagging - 76 to 125 items $3,657.00 per site

Equipment Tagging - Every item over 125 per location is $35.00 per item

For a more precise estimate please provide total number of locations with more than 125 and the total numbers of items at each locations.
# of locations with 45 items or less
Tagging Cost
# of locations with 46-75 items
Tagging Cost
# of locations with 76-125 items
Tagging Cost
# of items over 125
Tagging Cost
Total Locations
Total Tagging Cost

Travel Estimate
Locations less than 50 miles from nearest tech - $125.75 per site

Locations 50-200 miles from nearest tech - $314.30 per site
# of locations less than 50 miles
Travel Cost
# of locations 50-200 miles
Travel Cost
Locations > 200 miles
Number of locations over 200 miles will be quoted per location based on miles and hours of travel. This is an estimate only. Actual miles and hours will be billed.
Total Travel Locations
Total Travel Cost
Type a question
Total locations in section 1 must match total travel locations.

Total Setup Cost Estimate
Tagging and Travel Cost
Total Investment
Monthly Fee Estimate
Monthly Fee
Total Locations

Total Monthly Fees
Total Annual Fee
Total 1st Year Investment
Customer Acknowledgement of Receipt
Customer Initials
Business Legal Name
Mailing Address

Street Address

Street Address Line 2

CityState

Zip Code
Date

MonthDayYear
This is a quote and shall not be considered a legally binding document. This quote is confidential and should not be copied, distributed or reproduced, in whole or in part, nor passed to any third party.

Quote good for 30 days.

Account Type
Type
Should be Empty:

Number of Locations	Monthly Access Fee VirtualTech subscription cost to customer
Single Practice	$149
2-10 Practices	$139
11-25 Practices	$129
26-50 Practices	$120
51-399 Practices	$111
400+ Practices	$99

Equipment Health Solution Quote

Equipment Health Solution Quote

Customer Information

MWI Info

Equipment Tagging Estimate

Standard Tagging Calculator

EHS Installation Experience Asset Tagging

Travel Estimate

Total Setup Cost Estimate

Monthly Fee Estimate

Customer Acknowledgement of Receipt