Request RMA | RepairMED

Request RMA Form

Please complete the RMA Form below, ensuring to include:

• How many items to add to RMA Request (if shipping more than 5 items, please fill out form again for new RMA Request #'s.)
• The Manufacturer, Serial Number, Model Number, and Purchase Order Number for each device.
• Facility name, Organization, and Contact information complete with Phone Number and email
• Return ship to Address

After submission of Request Form, a RMA/packing slip will be emailed to you shortly to the address submitted in your online request.

If you need to ship more than 5 items in one RMA Request, you also have the option to email your shipment information directly to biomed@repairmed.net.

Name*
First Last
Organization*
Email*
Phone*
Return Shipping Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Number of Devices to Ship*
Choose the number of devices to add to your RMA Request. If shipping more than 3 items, please select the appropriate radio button and ENTER the MANUFACTURER, MODEL, AND SERIAL NUMBER in the box that appears.
- 1
- 2
- 3
- 4
- 5
Device #1
Device 1 Manufacturer*
Device 1 Model*
Device 1 Serial #*
Device 1 Purchase Order Number (if applicable)
Device 1: Please enter comments regarding the report complaint/failure with device.*
Device #2
Device 2 Manufacturer*
Device 2 Model*
Device 2 Serial #*
Device 2 Purchase Order Number (if applicable)
Device 2: Please enter comments regarding the report complaint/failure with device.*
Device #3
Device 3 Manufacturer*
Device 3 Model*
Device 3 Serial #*
Device 3 Purchase Order Number (if applicable)
Device 3: Please enter comments regarding the report complaint/failure with device.*
Device #4
Device 4 Manufacturer*
Device 4 Model*
Device 4 Serial #*
Device 4 Purchase Order Number (if applicable)
Device 4: Please enter comments regarding the report complaint/failure with device.*
Device #5
Device 5 Manufacturer*
Device 5 Model*
Device 5 Serial #*
Device 5 Purchase Order Number (if applicable)
Device 5: Please enter comments regarding the report complaint/failure with device.*
Payment Info
If you have a Purchase Order #, please list it by the appropriate item above. If you prefer to pay using a credit card, please call 855.813.8100 or email biomed@repairmed.net to arrange credit card payment or for any additional questions about your RMA Request.
Name
This field is for validation purposes and should be left unchanged.

RPMFL-016 Rev. A 12/22/2017

Request RMA Form

Device #1

Device #2

Device #3

Device #4

Device #5

Payment Info