RGA Request

MedEquip Order #*

Customer Order #

Company Name

Contact Person

First NameLast Name

E-mail

Product P/N*

Manufacturer

Reason for Return*

MedEquip shipped me the wrong product.The product arrived damaged in transportation.The product arrived incomplete.The product does not match description.I accidentally ordered the incorrect product.The product is defective.I changed my mind.The product took too long to arrive.Other (if you select this option, please explain below.)

Reason for Return (Other)

Is a Replacement Requested?

YesNo

We will contact you with an RGA and specific instructions for return. Please do not ship the product before you receive this information. Thank you!