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?
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 standing/sitting or walking/being pushed when equipment broke or failed?
If a Rollator - does the user ever sit and scoot?

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

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

YesNo
Was Patient injured/harmed when defect occurred?
For BestCare patient lift parts, please provide the serial numbers and/or date of manufacture of the parts (battery packs, actuators, pumps, etc)
For BestCare patient lifts, would you like a troubleshooting call set up first or advanced replacement with no troubleshooting call (advanced replacement will incur shipping charge)
Product Image(s)

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

Upload a File

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

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

Browse Files

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Additional File Upload

Browse Files

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Upload Picture 2

Upload a File

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Take a Photo
Status
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Request for Return Merchandise Authorization

Product Image(s)