Repair Authority Equipment Packing List

Equipment Packing List
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Point of Contact

First NameLast Name
Point of Contact's Title
Phone Number
Format: (000) 000-0000.
Email
A PDF of this completed form will be emailed to this address for inclusion with your equipment.
Which Repair Authority service center will you be sending this equipment to?

Device Information
Complete the following information for each unit being sent. Press the + sign to add additional units.
CPAP UNITS
STATIONARY OXYGEN CONCENTRATORS
PORTABLE OXYGEN CONCENTRATORS
PLEASE NOTE: Repair Authority authorized to repair the Drive iGo with serial numbers that start with D217 and above, as well as serial numbers that begin with the letter F (Generation 3 iGo model). Repairs for this unit can be completed at both our Ohio and Texas service centers.
OTHER EQUIPMENT
Please attach this completed form to your equipment before either pickup or shipping (whichever applies). If shipping, use the following addresses:

Repair Authority Headquarters/Ohio Service Center
21973 Commerce Parkway, Dock 4
Strongsville, OH 44149
Questions: dealer@repairauthority.com or 888.828.1872

Thank you for choosing Repair Authority!
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Equipment Packing List