medical equipment we repair

Repair/RMA Request

The form below is designed to help us serve you in an efficient and effective manner. Upon completion, the contents of the form below will be submitted directly to our shipping/receiving department so we can make proper arrangements to repair your equipment in a timely manner.

Please be sure to complete this form completely, to help ensure that there will be no additional delays.
We will send an RMA shortly. If a request is sent after 4:30 pm EST, the RMA will be sent the next business day.
SHIP EQUIPMENT TO

100 Corporate Drive, Suite G
Spartanburg, SC 29303

864-599-1922
864-599-1921
Date:
PO#

Contact Information

Facility Name*
First Name*
Last Name*
Email*
Phone*
Address*
Billing City*
State*
Zip Code*
Ship To Address: If Different From Above
Address1
Address2
Shipping City
State
Zip Code

Repair Information

Model

Serial No.

Problem/Fault

All Repairs are shipped Ups ground at no charge to customer. If other return method is selected, customer will be charged shipping fees unless account # is given.

NOTE: Security Code is case sensitive