Return Merchandise Form

Request for Return Merchandise Authorization

Please fill out the following form so Lake Court can begin processing your return(s).
Questions about your return? Please contact returns@lakecourt.com.

Please note that all requests for return(s) of merchandise are subject to evaluation and approval, please see Lake Court's Terms & Conditons for our return policy.
Questions? E-mail
Customer ID*
Customer Name*
Address 1*
e.g. 123 Lake Court Drive
Address 2
e.g. Unit 1
Address 3
e.g. Mailbox# 1991
City*
State*
Zip Code*
Contact Name*
Receiving Hours for Pickup (if pickup is required)
Please enter hours (e.g., 9AM-1PM EST)
Phone Number

Area CodePhone Number
E-mail*
Reason for Return
Reason for Return*

Defective - New Out of the BoxDefective - In the FieldOrder IssueOther
Item Number*
Quantity *
Make, Model, Color
If concentrator, how many hours on unit?
If a rollator - does the user ever site and scoot?
Date Purchased

MonthDayYear
Detailed Description of Reason being returned*
PO or Invoice Number*
Serial Number or Lot Number and Date of Manufacture (if applicable - enter NA for not Applicable). If multiple products, please separate serial numbers with a comma. *
If POC, please include sieve bed serial number.
Credit, Repair or Replacement
Credit, Repair, or Replacement?*

CreditReplacementRepair
Who has the equipment?
Who has the Equipment?*

DealerPatient
Who has the equipment - patient or dealer?
If applicable, patients height and weight?
Was patient in or using equipment when it broke/failed?
If a Rollator - does the user ever site and scoot?

YesNo
If a Rollator - doe the user ever get pushed while seated?

YesNo
If Transport Chair, does the user ever site and scoot?

YesNo
Was Patient injured/harmed when defect occurred?
Product Image(s)

If the product is damaged, please upload images of the damage below.
Upload Picture(s) or Document(s)

Upload a File

Cancelof
Upload Picture(s) and/or Document(s)

Select Files
You are able to upload more than one file if necessary. Cancelof
Upload Picture 2

Upload a File

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Take a Photo
Status
Should be Empty:

Request for Return Merchandise Authorization

Product Image(s)